PREDICTIVE VALUE OF PROMINENT PULMONARY ARTERIAL WEDGE V-WAVES IN ASSESSING THE PRESENCE AND SEVERITY OF MITRAL REGURGITATION

Indwelling Pulmonary arterial catheters are often used to monitor and to guide therapy in critically ill patients. The magnitude of the V wa ve recorded from the pulmonary arterial wedge (PAW) position is someti mes used to assess the presence and severity of mitral regurgitation ( MR). The present study was performed to assess the relation (or lack t hereof) between a ''prominent'' PAW V wave and qualitative and quantit ative estimates of MR. In 903 subjects (445 men and 458 women, aged 49 +/- 13 [mean +/- SD] years) referred for cardiac catheterization, an oximetrically confirmed PAW pressure was recorded with a large-lumen s tiff catheter, and a left ventriculogram was recorded. In 646 of these subjects (328 men and 318 women, aged 50 +/- 13 years), forward cardi ac output was measured by the Fick principle, and a regurgitant fracti on was calculated. Prominent PAW V waves-as defined in several ways-we re insensitive and had poor positive predictive value in identifying m oderate or severe MR. At the same time, the absence of prominent PAW V waves was relatively specific for the absence of moderate or severe M R, and the negative predictive value of small V waves was very good. T hus, the prominence of a PAW V wave cannot be used to assess the prese nce or severity of MR.