Relationship of echocardiographic indices to pulmonary capillary wedge pressures in healthy volunteers

OBJECTIVES We sought to determine the relationship between different echoca rdiographic indices and pulmonary capillary wedge pressures (PCWP) in norma l volunteers. BACKGROUND Indices based on tissue Doppler (TDE) and color M-mode (CMM) ech ocardiography have been proposed to reflect left (LV) ventricular filling p ressures. These include the ratio of early diastolic transmitral velocity ( E) to early myocardial velocity measured by TDE (E') and the ratio off to t he wave propagation velocity (Vp) measured from CMM images. These indices, however, have not been validated in normal individuals. METHODS We studied seven volunteers during two phases of preload altering m aneuvers, baseline, with two stages of lower body negative pressure, and re peat baseline with two stages of volume loading. The PCWP obtained from rig ht heart catheterization was compared with diastolic indices using pulsed D oppler, TDE and CMM echocardiography. RESULTS The PCWP ranged from 2.2 to 23.5 mm Hg. During preload alterations, significant changes in E and septal E' (both p < 0.05) but not lateral E' or Vp were observed. Furthermore, E, septal E' and E/Vp correlated with PCW P (all r > 0.80) but not combined E and TDE indices (both r < 0.15). Within individuals, a similar linear relationship was observed among E/Vp, E and septal E' (average r > 0.80). CONCLUSIONS In subjects without heart disease, E, septal E' and E/Vp correl ate with PCWP. Because the influence of ventricular relaxation is minimized , the ratio E/Vp, may be the best overall index of LV filling pressures. (C ) 2000 by the American College of Cardiology.