PROSPECTIVE-STUDY COMPARING DIFFERENT ECHOCARDIOGRAPHIC MEASUREMENTS OF PULMONARY CAPILLARY WEDGE PRESSURE IN PATIENTS WITH ORGANIC HEART-DISEASE OTHER THAN MITRAL-STENOSIS

[摘要] In 25 patients with cardiac disease, but free of left ventricular inflow obstruction, the ECG and M-mode echocardiogram of the aortic root, left atrium and both the mitral and the aortic valves were obtained simultaneously with the pulmonary artery wedge pressure (PAWP) during right heart catheterization. The echocardiographic measurements of the left atrial size, PR-AC interval, left atrial emptying index and the ratio between the ECG Q wave to mitral valve closure (Q-MVC) and between aortic valve closure to the mitral E point (AVC-E) were correlated to the pulmonary artery wedge pressure by means of linear regression analysis. A formula in which PAWP = 36.6 (Q-MVC/AVC-E)-2 was prospectively used to study the measured pressure in the current group of patients. The pulmonary artery wedge pressure derived from these latter measurements correlated well with the invasive measurement correlated well with the invasive measurement of this pressure (r = 0.91). The pulmonary artery wedge pressure calculated by echocardiography differed from the pulmonary artery wedge pressure measured by catheterization by 3 mm Hg or less in 19 of the 25 patients, by 4 mm Hg or less in 22 patients and by 6 mm Hg or less in 24 patients. Although the correlation between the (Q-MVC/AVC-E) ratio and measured pulmonary artery wedge pressure was highly significant (r = 0.91, probability P < 0.001, n = 25), the left atrial emptying index, PR-AC and left atrial size revealed poor correlation coefficients (r = 0.45, r = 0.45 and r = 0.56 [P < 0.05]), respectively. In patients in stable condition with left ventricular dysfunction but without mitral valve obstruction, M-mode echocardiography using a ratio of the intervals (Q-MVC/AVC-E) provides a useful and reliable noninvasive method to predict pulmonary artery wedge pressure. Other M-mode echocardiographic measurements, PR-AC interval, left atrial emptying index and left atrial size, have limited use as a noninvasive method to predict pulmonary artery wedge pressure.