DOPPLER-DERIVED MITRAL DECELERATION TIME OF EARLY FILLING AS A STRONGPREDICTOR OF PULMONARY CAPILLARY WEDGE PRESSURE IN POSTINFARCTION PATIENTS WITH LEFT-VENTRICULAR SYSTOLIC DYSFUNCTION

Objectives. The aim of this study was to investigate the correlations between Doppler-derived transmitral flow velocity variables and pulmon ary capillary wedge pressure in patients with severe left ventricular systolic dysfunction. Background. Abnormal relaxation and increased ch amber stiffness have opposing effects on the left ventricular filling pat tern. When both abnormalities are present at the same time, as oft en occurs in patients with systolic dysfunction, the ability of Dopple r recording to assess diastolic function and predict left ventricular filling pressure may be significantly compromised. Method. Pulmonary c apillary wedge pressure and Doppler transmitral Bow velocity profile w ere simultaneously recorded in 140 postinfarction patients with ejecti on fraction less than or equal to 35%. Results. Correlation between th e ratio of mitral peak Bow velocity in early diastole to peak Bow velo city in late diastole (E/A ratio) and pulmonary capillary wedge pressu re was weak (r = 0.65). Although the specificity of E/A greater than o r equal to 2 in predicting greater than or equal to 20 mm Hg in pulmon ary capillary wedge pressure was high (99%), its sensitivity was low ( 43%). Conversely, a very close negative correlation was found between mitral deceleration time of early filling and pulmonary capillary wedg e pressure (r = -0.90). Sensitivity and specificity of less than or eq ual to 120 ms in deceleration time in predicting greater than or equal to 20 mm Hg in pulmonary capillary wedge pressure were 100% and 99%, respectively. Conclusions. Doppler derived mitral deceleration time of early filling provides a simple and accurate means of estimating pulm onary capillary wedge pressure that is particularly useful in patients with a normal or normalized mitral flow velocity pattern.