Can transthoracic Doppler echocardiography predict the discrepancy between left ventricular end-diastolic pressure and mean pulmonary capillary wedge pressure in patients with heart failure?
Can transthoracic Doppler echocardiography predict the discrepancy between left ventricular end-diastolic pressure and mean pulmonary capillary wedge pressure in patients with heart failure?
复制标题
DOI：
10.1253/circj.69.432
复制
发表时间：
2005-04-01
影响因子：
3.3
通讯作者：
Matsuzaki, M
中科院分区：
文献类型：
--
作者：
Hadano, Y;Murata, K;Matsuzaki, M
背景：左室舒张末期压（LVEDP）难以连续测量；因此，肺动脉毛细血管楔压（PCWP）常被用于心衰患者的血流动力学监测。然而，有时会观察到LVEDP与平均PCWP之间的差异。方法与结果为评价超声多普勒指数评价这种差异的可行性，对连续140例心脏病患者进行了研究。经胸多普勒超声心动图（TTDE）立即进行双侧心导管。我们测量了早期（E: cm/s）和晚期（A: cm/s）舒张透射血流峰值速度和A波持续时间（MAd: ms）。我们还测量了肺静脉血流心房逆转的持续时间（PAd: ms）。计算PAd与MAd的差值（d= PAd-MAd: ms）。计算二尖瓣环早期舒张峰值速度（Ea: cm/s）与E的比值（E/Ea）。LVEDP与Ad呈正相关（r=0.77, p < 0.001）。平均PCWP与E/Ea呈正相关（r=0.56, p < 0.001）。当患者以δ d >= 10ms, E/Ea = 17mmHg)和正常平均PCWP (
Background Left ventricular end-diastolic pressure (LVEDP) is difficult to measure continuously; therefore, pulmonary capillary wedge pressure (PCWP) is frequently used instead for hemodynamic monitoring in patients with heart failure. However, a discrepancy between LVEDP and mean PCWP is sometimes observed.Methods and Results To assess the feasibility of evaluating this discrepancy using echo-Doppler indexes, 140 consecutive patients with heart disease were studied. Transthoracic Doppler echocardiography (TTDE) was performed immediately before bilateral-sided cardiac catheterization. We measured peak velocities of early (E: cm/s) and late (A: cm/s) diastolic transmitral flow, and duration of A wave (MAd: ms). We also measured the duration of atrial reversal of pulmonary venous flow (PAd: ms). The difference between PAd and MAd (Delta d= PAd-MAd: ms) was calculated. The ratio of E to tissue Doppler-derived peak early diastolic velocity of mitral annulus (Ea: cm/s) was also calculated (E/Ea). There was a good positive correlation between LVEDP and Ad (r=0.77, p < 0.001). There was a modest correlation between mean PCWP and E/Ea (r=0.56, p < 0.001). When patients were classified by Delta d >= 10ms and E/Ea = 17mmHg) and normal mean PCWP (