ESTIMATION OF LEFT AND RIGHT-VENTRICULAR FILLING PRESSURES AFTER HEART-TRANSPLANTATION BY TISSUE DOPPLER IMAGING

Current Doppler methods have been unreliable in estimating filling pre ssures in heart transplants. Tissue Doppler imaging is a technique tha t permits evaluation of myocardial relaxation; combined with transvalv ular E velocity, it could improve estimation of these pressures. To in vestigate this possibility, we evaluated 50 patients by right-sided ca rdiac catheterization and Doppler echocardiography simultaneously. The ir mean +/-SD age wets 53 +/- 15 years and the mean age of donor heart s was 30 +/- 12.5 years. The mitral E velocity was combined with the e arly myocardial relaxation (Ea) velocity by tissue Doppler at the late ral border of the mitral annulus. Likewise, the tricuspid E velocity w as combined with Ea at the lateral corner of the tricuspid annulus. Me an wedge pressure related weakly to mitral inflow variables but strong ly to E/Ea [r = 0.8; wedge pressure = 2.6 +/- 1.46(E/Ea)]. In 25 repea t right-sided cardiac catheterizations, changes in mean wedge pressure were well detected by Doppler, with a mean difference of -0.7 +/- 3 m m Hg. Mean right atrial pressure related weakly to routine tricuspid i nflow variables but strongly to tricuspid E/Ea [r = 0.79; n = 38; righ t atrial pressure = 1.76(E/Ea) - 3.7]. In 18 repeat right-sided cardia c catheterizations, changes in mean right atrial pressure were well de tected by Doppler, with a mean difference of 0 +/- 3.45 mm Hg. Mean we dge pressure and mean right atrial pressure can be estimated in heart transplants with reasonable accuracy using the ratio of E/Ea. Furtherm ore, this method can accurately track changes in filling pressures. (C )1998 by Excerpta Medico, Inc.