Can Transthoracic Doppler Echocardiography Predict the Discrepancy Between Left Ventricular End-Diastolic Pressure and Mean Pulmonary Capillary Wedge Pressure in Patients With Heart Failure?

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• 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 (△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 △d (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 △d≥10ms and E/Ea≥14, elevated LVEDP (≥17mmHg) and normal mean PCWP (≥12mmHg) were predicted with 100% sensitivity and 85% specificity. Conclusions Evaluation of the discrepancy between LVEDP and mean PCWP in patients with heart failure was feasible by separately estimating LVEDP by △d and mean PCWP by E/Ea using noninvasive TTDE. Early detection of patients with elevated LVEDP and normal mean PCWP may be useful for preventing acute exacerbation of chronic heart failure.

• 社団法人日本循環器学会の論文
• 2005-03-20

著者

• Matsuzaki Masunori

  Department of Medicine and Clinical Science, Division of Cardiology, Yamaguchi University Graduate S

• TANAKA Nobuaki

  Department of Orthodontics and Craniofacial Developmental Biology, Hiroshima University Graduate Sch

• Harada Nozomu

  Department of Cardiovascular Medicine, Yamaguchi University School of Medicine

• HADANO Yasuyuki

  Department of Medicine and Clinical Sciences, Yamaguchi University Graduate School of Medicine

• OHYAMA Rikimaru

  Department of Medicine and Clinical Sciences, Yamaguchi University Graduate School of Medicine

• OKUDA Shinichi

  Department of Medicine and Clinical Sciences, Yamaguchi University Graduate School of Medicine

• Okuda Shinichi

  Yamaguchi University Graduate School of Medicine

• Liu Jinyao

  Department of Medical Bioregulation, Division of Cardiovascular Medicine, Yamaguchi University Schoo

• Murata Kazuya

  Department of Pharmacy, Nippon Medical School, Tama-Nagayama Hospital

• Hamada Yoko

  Department of Biomaterials, Institute for Frontier Medical Sciences, Kyoto University

• Liu Jinyao

  Department Of Medical Bioregulation Division Of Cardiovascular Medicine Yamaguchi University School

• Tanaka Nobuaki

  Department Of Clinical Laboratory Medicine Yamaguchi Grand Medical Center

• Tanaka Nobuaki

  Division Of Cardiology Department Of Medicine And Clinical Science Yamaguchi University Graduate Sch

• Liu Jinyao

  Department Of Legal Medicine Yamaguchi University School Of Medicine

• Harada Nozomu

  Department Of Cardiovascular Medicine Yamaguchi University Graduate School Of Medicine

• Okuda Shinichi

  Department Of Medicine And Clinical Sciences Yamaguchi University Graduate School Of Medicine

• Matsuzaki Masunori

  Department Of Cardiology Kyushu Kousei-nenkin Hospital

• Oyama Rikimaru

  Department of Cardiovascular Medicine, Yamaguchi University Graduate School of Medicine

• Hadano Yasuyuki

  Department Of Medicine And Clinical Sciences Yamaguchi University Graduate School Of Medicine

• Ohyama Rikimaru

  Department Of Medicine And Clinical Sciences Yamaguchi University Graduate School Of Medicine

• Tanaka Nobuaki

  Department Of Clinical Laboratory Yamaguchi University Hospital

• Hamada Yoko

  Department Of Cardiovascular Medicine Yamaguchi University Graduate School Of Medicine

• Murata Kazuya

  Department Of Medical Bioregulation Division Of Cardiovascular Medicine Yamaguchi University School

• Hadano Yasuyuki

  Division Of Cardiology Tokuyama Central Hospital

• Okuda Shinichi

  Department Of Cardiology Shimane Prefectural Central Hospital

• Tanaka Nobuaki

  Department Of Applied Chemistry Faculty Of Engineering Okayama University

• Tanaka Nobuaki

  Department Of Cardiology Yamaguchi Grand Medical Center

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