ASSESSMENT OF LEFT-VENTRICULAR FILLING PRESSURES BY DOPPLER IN THE PRESENCE OF ATRIAL-FIBRILLATION

Background Although Doppler echocardiography can be used to estimate l eft ventricular filling pressures (LVFPs) in patients in sinus rhythm, its utility in atrial fibrillation is unknown. Methods and Results An initial training population of 30 patients (17 men, 13 women; mean ag e, 69+/-9 years; range, 48 to 87 years) was studied. Measurements of L VFP were obtained simultaneously with pulsed Doppler recordings of mit ral and pulmonary venous how velocities and color M-mode recording of the flow propagation velocity of the mitral inflow. Measurements were averaged over 10 cardiac cycles. In addition, left atrial volume was d erived from the apical four-chamber view. Significant relations were o bserved between LVFP and several parameters derived from the transmitr al and pulmonary venous velocity and left atrial volume. The best rela tions were observed with the peak acceleration (PkAcc) of the mitral v elocity (r=.84), isovolumic relaxation time (IVRT) (r=-.76), mean earl y (E) velocity (r=.6), and the ratio of peak E velocity to color M-mod e flow propagation velocity (r=.65). The best model. obtained by multi linear regression analysis (r=.88) included PkAcc rind IVRT. The equat ion LVFP=22+/-0.005 (PkAcc)-0.183(IVRT) was tested in 30 additional pa tients (12 women and 18 men; mean age, 65+/-10.6 years; range, 43 to 8 7 years) with similar results (r=.87). When all 60 patients were combi ned, the mean+/-SD difference between predicted and observed pressure was -0.88+/-3.6 mm Hg. Conclusions LVFPs can be estimated with Doppler echocardiography in patients with atrial fibrillation.