The Association Between Doppler Transmitral Flow Variables Measured by Transesophageal Echocardiography and Pulmonary Capillary Wedge Pressure

• Published in: Anesthesia and analgesia Vol. 84; no. 3; pp. 491 - 496
• Main Authors: Nomura, Minoru, Hillel, Zak, Shih, Henry, Kuroda, Maxine M., Thys, Daniel M.
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD International Anesthesia Research Society 01-03-1997; Lippincott
• Subjects: Age Factors; Biological and medical sciences; Blood Flow Velocity; Body Weight; Capillaries; Diastole; Echocardiography, Transesophageal - methods; Hemodynamics; Humans; Medical sciences; Middle Aged; Mitral Valve; Prospective Studies; Pulmonary Wedge Pressure - physiology; Regression Analysis; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Sonography; Doppler ultrasound study; Human; Mitral valve; Echocardiography; Cardiovascular disease; Pulmonary wedge pressure; Coronary heart disease; Blood flow; Aortocoronary; Bypass; Surgery; Hemodynamics; Left ventricle performance; Esophageal route; Monitoring
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1097/00000539-199703000-00004

The association between Doppler transmitral flow variables, measured by transesophageal echocardiography (TEE), and pulmonary capillary wedge pressure (PCWP) was studied in 88 patients undergoing coronary artery surgery.The Doppler flow variables and PCWP were measured after sternotomy by blinded investigators. In the first part of the study, patients were divided into two groups according to left ventricular (LV) ejection fraction (EF)Group A, EF >35% (n = 38) and Group B, EF <or=to35% (n = 34). In Group B, significant correlations were found between deceleration time of early filling (DCT-E) and PCWP (r = 0.899) and deceleration slope of early filling and PCWP (r = 0.692), (P < 0.001 for both). When the relationship between DCT-E and PCWP was tested prospectively in a third group of patients [Group C; EF <or=to 35% (n = 16)], a close agreement between the calculated and measured PCWP (bias = -0.55 +/- 3.87 mm Hg) was noted. The sensitivity, specificity, and positive predictive value of DCT-E >or=to150 ms for PCWP <10 mm Hg were 93.3%, 100%, and 100%, respectively. In summary, patients with decreased left ventricular systolic function undergoing coronary artery surgery demonstrated high, statistically significant, correlations between PCWP and the deceleration time or deceleration slope of early diastolic filling as measured by transesophageal Doppler echocardiography.(Anesth Analg 1997;84:491-6)