RELATIONSHIP BETWEEN DOPPLER-DERIVED TRAN SMITRAL FLOW PROFILE AND PULMONARY WEDGE PRESSURE DURING EXERCISE-INDUCED MYOCARDIAL-ISCHEMIA

The way Doppler-derived transmitral filling patterns are changed becau se of myocardial ischemia is controversial. Furthermore, the influence of the filling pressure has not been investigated sufficiently. To ev aluate the relationship between transmitral flow profile and pulmonary capillary wedge pressure (PC), 35 patients with exercise-induced myoc ardial ischemia were examined. Both Doppler-derived transmitral fillin g patterns and PC were determined simultaneously at rest and during th ree stages of supine bicycle exercise. Patients were subdivided into t wo groups according to the hemodynamic response (group 1 = PC < 20 mm Hg; n = 10, and group 2 = PC 1 20 mm Hg; n = 25). The correlation betw een PC and transmitral filling patterns was low at rest for all patien ts, but improved at maximal workload, particularly for the atrial cont ribution (r = -0.79), as well as the ratio of maximal and integrated e arly to late diastolic flow velocities (r(E/A) = 0.74; r(Ei/Ai) = 0.72 ). Both groups revealed different flow profiles in regard to the hemod ynamic response. While group 1 showed an E/A-ratio < 1, an E/A-ratio > 1 was registered in group 2 (0.9 m/s versus 1.61 mis; p < 0.001). Exe rcise-induced myocardial ischemia lead to different Doppler-derived tr ansmitral flow patterns with regard to the filling pressure. The relat ionship to the pulmonary capillary wedge pressure is so close that an E/A-ratio > 1 is a reliable parameter to predict a filling pressure > 20 mm Hg.