© 2003 by European Society of Cardiology
Copyright © 2003, The European Society of Cardiology
Non-invasive estimation of left ventricular end-diastolic pressure by pulmonary venous flow deceleration time
Klinik für Innere Medizin/Kardiologie Deutsches Herzzentrum Berlin, Berlin, Germany
Received 9 January 2002; accepted after revision 9 October 2002.
* Address correspondence to: Ernst Wellnhofer, Klinik für Innere Medizin/Kardiologie, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. Tel/Fax: +49 30 4593 2463. ewellnhofer{at}t-online.de
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Abstract |
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Aims: The scope of this study was to assess the potential value of pulmonary venous flow diastolic deceleration time to predict end-diastolic pressure and stratify patients with regard to elevation of left ventricular end-diastolic pressures.
Methods and Results: In 174 consecutive patients, pulmonary venous flow diastolic deceleration time was determined and compared with left ventricular end-diastolic pressures measured invasively. The sample was randomly divided into two subgroups of equal size for modelling of prediction and independent testing of the model. Predicted left ventricular end-diastolic pressures calculated from pulmonary venous flow diastolic deceleration time (left ventricular end-diastolic pressures = –10.87 + 5261/pulmonary venous flow diastolic deceleration time) agreed well with measured left ventricular end-diastolic pressures (mean difference: -1.3 ± 3.4 mmHg). The correlation of left ventricular end-diastolic pressures with pulmonary venous flow diastolic deceleration time is fair (r=0.73989). A value of pulmonary venous flow diastolic deceleration time <220 ms is suggestive of elevated left ventricular end-diastolic pressures and should be monitored. A value of pulmonary venous flow diastolic deceleration time <190 ms predicts elevated left ventricular end-diastolic pressures. A value of pulmonary venous flow diastolic deceleration time <165 ms predicts severely elevated left ventricular end-diastolic pressures. With 190 ms as a cut-off value for elevated and 165 ms for severely elevated left ventricular end-diastolic pressures, cross-table analysis classifies all patients with normal left ventricular end-diastolic pressures correctly. No patient with severe elevation (<18 mmHg) of left ventricular end-diastolic pressures is classified as normal (
2=102, P<0.0001).
Conclusion: Pulmonary venous flow diastolic deceleration time is an appropriate non-invasive measurement to stratify patients with respect to elevation of left ventricular end-diastolic pressures.
Keywords: AR the reversal of flow from the left atrium to the pulmonary veins during atrial contraction; vAR, dAR the velocity and duration of AR; E, A waves waves of the diastolic transmitral flow; E-dt deceleration time of the E wave; dA the duration of the A wave; IVRT isovolumic relaxation time
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