FEASIBILITY OF OBTAINING PULMONARY VENOUS FLOW VELOCITY IN CARDIAC PATIENTS USING TRANSTHORACIC PULSED WAVE DOPPLER TECHNIQUE

The purpose of this study was to determine, in an adult population, th e percentage of patients in whom high quality pulmonary venous flow ve locity recordings can be obtained using current transthoracic pulsed w ave Doppler techniques. Pulmonary venous and mitral flow velocity vari ables obtained with a pulsed wave Doppler method were used for the ind irect assessment of left ventricular (LV) diastolic function and LV fi lling pressures. The general clinical use of these methods, however, r emains uncertain because the transthoracic success rate of obtaining a ll components of pulmonary venous flow velocity has been variable, and sometimes reported to be as low as 30% to 60%. Mitral and pulmonary v enous flow velocity variables were obtained using pulsed wave Doppler signals in 200 consecutive adult patients (mean age 68.2 +/- 11.4 year s) in normal sinus rhythm who were referred for echocardiographic stud y. Six cardiac sonographers and five ultra sound systems were used. Th e success rate for obtaining pulmonary venous systolic and diastolic h ow velocity was 95%, reverse flow velocity at atrial contraction was 9 0%, and the duration of reverse flow at atrial contraction was 89%. In the 5% to 11% of patients in whom pulmonary flow velocities could not be adequately recorded, the most common reasons were depth limitation s of the pulsed wave Doppler machine, marked cardiac enlargement, or l eft atrial wall motion artifact. The success rate also was influenced by the ultrasound equipment used, individual variation among sonograph ers, and even the type (impaired, pseudonormal, restricted) of associa ted mitral filling pattern. Given current machine teehnology, sonograp her education, and daily practice, high quality, complete recordings o f pulmonary venous how velocity can be obtained in approximately 90% o f adult patients using the precordial transthoracic Doppler technique. These results suggest that using these variables as an aid for evalua ting LV diastolic function and filling pressures may have broader clin ical applicability than previously appreciated.