Left ventricular end-diastolic pressure can be estimated by either changesin transmitral inflow pattern during valsalva maneuver or analysis of pulmonary venous flow

We directly compared the transmitral inflow pattern during preload reductio n and pulmonary venous now velocities to determine left ventricular end-dia stolic pressure (LVEDP) in 78 patients who underwent left heart catheteriza tion. Transmitral Inflow indexes (A-wave duration, ratio of peak now veloci ty of early diastole [E] to peak flow velocity of late diastole during atri al contraction [A] [E/A ratio]) at rest and during the Valsalva maneuver (3 0 mm Hg for 15 seconds) and Indexes of pulmonary venous flow (velocity and duration of the atrial reversal) were obtained. Fair correlations existed b etween LVEDP A(mean 15 +/- 6 mm Hg) and the percentage decrease In the E/A ratio (r = 0.72), increase in duration of A wave during the Valsalva maneuv er (r = 0.60), now velocity of atrial reversal (r = 0.58), and difference o f duration of atrial Mow reversal and A wave (r = 0.62) (all P < .001). Whi le sensitivity, specificity, and diagnostic accuracy to detect an elevated LVEDP were comparable, technically adequate Doppler recordings were obtaine d more often for the mitral inflow during the Valsalva maneuver than for th e pulmonary venous now (72 versus 66 patients, P < 0.05).