Noninvasive assessment of hemodynamic subsets in patients with acute myocardial infarction using digital color Doppler velocity profile integration and pulmonary venous flow analysis

Four major hemodynamic subsets from cardiac index (CI) and mean pulmonary a rtery (PA) wedge pressure with ct PA catheter usually reflect clinical stat us and prognosis of patients with acute myocardial infarction (AMI). Recent ly, a new color Doppler technique has been developed for automated cardiac output measurements (ACOM). Color Doppler echocardiography also provides no ninvasive estimation of PA wedge pressure from pulmonary venous.(PV)flow an alysis. This study evaluates the valve of ACOM and PV flow analysis by colo r Doppler echocardiography for the assessment of hemodynamic subsets in pat ients with AMI. We performed ACOM and PV flow analysis by color Doppler ech ocardiography in 55 patients with AMI who underwent hemodynamic assessment with a PA catheter. From both noninvasive and invasive methods, we classifi ed hemodynamic subsets as follows: subset I: normal hemodynamics (CI >2.2 L /min/m(2), PA wedge pressure less than or equal to 18 mm Hg); subset II: pu lmonary congestion (CI >2.2 L/min/m(2), PA wedge pressure >18 mm Hg); subse t ill: peripheral hypoperfusion (CI less than or equal to 2.2 L/min/m(2), P A wedge pressure less than or equal to 18 mm Hg); and subset IV: pulmonary congestion and peripheral hypoperfusion (CI less than or equal to 2.2 L/min /m(2), PA wedge pressure >18 mm Hg). Doppler assessment of hemodynamic subs ets was possible in 50 of 55 patients (91%). CI from ACOM correlated well w ith that from the thermodilution method (r = 0.94) with close agreement. Th ere was a good correlation between the systolic fraction (systolic velocity -time integral expressed as a fraction of the sum of systolic and diastolic velocity-time integrals) of PV flow and PA wedge pressure measured from ca rdiac catheterization (r -0.83), When we determined the value of 45% in the systolic fraction as the cut-off point in predicting >18 mm Hg in PA wedge pressure, there was 90% (45 of 50 patients) agreement between noninvasive and invasive hemodynamic subsets. Thus, ACOM and PV flow analysis by color Doppler echocardiography is useful in the noninvasive assessment of hemodyn amic subsets in patients with AMI. (C) 1999 by Excerpta Medica, Inc.