Comparison of transthoracic Doppler echocardiography and natriuretic peptides in predicting mean pulmonary capillary wedge pressure in patients with chronic atrial fibrillation

The purpose of this study was to assess whether transthoracic Doppler echoc ardiography and serum natriuretic peptide levels could predict mean pulmona ry capillary wedge pressure (PCWP) in patients with chronic atrial fibrilla tion. We examined mitral flow velocity and pulmonary venous flow (PVF) velo city patterns in 32 patients with chronic atrial fibrillation. Plasma A-typ e and B-type natriuretic peptide (ANP, BNP, respectively) levels in the per ipheral vein were measured. Significant correlations were observed between mean PCWP and the following: peak velocity (r = 0.51) and deceleration time (r = -0.65) of the mitral flow; peak velocity (r = 0.64) and deceleration time (r = -0.80) of the PVF; BNP (r = 0.60), and ANP (r = 0.36). Stepwise m ultiple linear regression analysis selected PVF deceleration time and mitra l flow deceleration time as independent predictors of PCWP. A cutoff value of PVF deceleration time of less than or equal to 150 ms and a mitral flow deceleration time of less than or equal to 100 ms predicted a mean PCWP of greater than or equal to 18 Hg, with a sensitivity of 100% and 80% and a sp ecificity of 96% and 85%, respectively. In conclusion, PVF deceleration tim e and mitral flow deceleration time obtained from transthoracic Doppler ech ocardiography are more accurate predictors of mean PCWP than values obtaine d with natriuretic peptides in patients with chronic atrial fibrillation.