WHAT IS THE MOST APPROPRIATE VARIABLE FOR ESTIMATION OF MEAN PULMONARY CAPILLARY WEDGE PRESSURE BY TRANSESOPHAGEAL PULSED DOPPLER-ECHOCARDIOGRAPHY

Although left ventricular (LV) inflow and pulmonary venous (PV) flow v ariables estimated by transesophageal Doppler echocardiography (TEE) r eflect pulmonary capillary wedge pressure (PCWP), they are also affect ed by changes in cardiac function. The purpose of the present study wa s to detect the most appropriate variable for the estimation of PCWP b y TEE in patients (pts) with ischemic heart disease. Several variables of LV inflow and left upper PV flow were compared with PCWP in 36 pts (six with angina pectoris and 30 with old myocardial infarction). Ear ly diastolic flow (E) and atrial contraction flow (A) were used as LV inflow while systolic forward flow (X), diastolic forward flow (Y) and atrial contractile reversal flow (z) were used as PV flow. The peak v elocity of each flow wave (Ep, Ap, Xp, Yp, and Zp) and the time-veloci ty integral (Ei, Ai, Xi, Yi, and Zi) were measured. The ratio of Ep to Ap (Ep/Ap), Ei to Ai (Ei/Ai), Xp to Yp (Xp/Yp), Xi to Yi (Xi/Yi), Zp to Ap (Zp/Ap), Zi to Ai (Zi/Ai) and the systolic fraction of PV forwar d flow were calculated. Among these variables, the Zi/Ai ratio was mos t strongly correlated with PCWP (R = 0.80). The Zi/Ai ratio may not be influenced by atrial function because the augmentation of atrial pump function increases Zi as well as Ai, and this may be one reason why t he ratio correlated well with PCWP. Conclusion: The Zi/Ai ratio is a n ew useful variable for estimating PCWP by TEE.