UTILITY OF PRELOAD ALTERATION IN ASSESSMENT OF LEFT-VENTRICULAR FILLING PRESSURE BY DOPPLER-ECHOCARDIOGRAPHY - A SIMULTANEOUS CATHETERIZATION AND DOPPLER-ECHOCARDIOGRAPHIC STUDY

Objectives. The aim of this study was to demonstrate the usefulness of preload alterations in assessing left ventricular filling pressures w ith transmitral Doppler velocity curves. Background. Doppler mitral in flow velocities, used to estimate left ventricular filling pressures n oninvasively, are limited in predicting left ventricular filling press ures, especially in patients with normal systolic function and a ''pse udonormal'' mitral filling pattern. Methods. Forty-nine patients were studied in the cardiac catheterization laboratory with simultaneous Do ppler echocardiography using high fidelity catheters to compare left v entricular diastolic filling pressures (pre-A wave left ventricular pr essure) and Doppler mitral inflow at baseline and during reduction of preload during the strain phase of the Valsalva maneuver (n = 27) or s ublingual nitroglycerin (n = 36), or both (n = 14). Doppler measuremen ts consisted of E (initial peak velocity), A (velocity at atrial contr action), deceleration time (time from E velocity to deceleration of ho w extrapolated to baseline) and absolute A wave velocity (A' [peak A w ave velocity minus velocity at onset of atrial contraction]). Results. In patients with high pre-A wave pressure (greater than or equal to 1 5 mm Hg), there was a greater change in the E/A' ratio during the Vals alva maneuver than in patients with a normal pre-A wave pressure (-1.2 2 +/- 1.1 vs. -0.35 +/- 0.17; p = 0.02). A similar change was seen whe n comparing the change in the E/A' ratio after administration of nitro glycerin in patients viith a high versus a normal pre-A wave pressure (0.81 +/- 0.49 vs. 0.18 +/- 0.17; p < 0.001), These differences were p resent in patients with a normal E/A ratio at baseline, Conclusions. A lterations in preload during assessment of Doppler echocardiographic i ndexes may be useful in noninvasively assessing left ventricular filli ng pressures. (C) 1997 by the American College of Cardiology.