Abstract
To determine whether transmitral and pulmonary venous flow velocity patterns can be used to evaluate left atrial pressure and volume changes during atrial systole, we performed transesophageal pulsed Doppler echocardiography and right heart catheterization in 85 patients (20 with hypertrophic cardiomyopathy, 20 with dilated cardiomyopathy, 30 with prior myocardial infarction, and 15 with mitral regurgitation), and 35 normal subjects. Pulsed Doppler variables from transmitral and pulmonary venous flow velocities dur-ing atrial systole were compared with mean pulmonary capillary wedge pressure (mean PCWP), pressure rise during atrial systole (PCWP-A), and left atrial volume change during atrial systole (ΔLAV). The mean PCWP correlated significantly with the peak atrial systolic transmitral flow (r=-0.38, p<0.05) and pulmonary venous flow (r=0.40, p<0.05) velocities in all patients. The PCWP-A correlated significantly with the peak atrial systolic transmitral flow (r=-0.39, p<0.05) and pulmonary venous flow (r=0.68, p<0.0001) velocities in all patients. There was a particularly close correlation between the PCWP-A and the peak atrial systolic pulmonary venous flow velocities. The sum of the time-velocity integral of the atrial systolic transmitral and pulmonary venous flow velocities (TAI) correlated closely with the ΔLAV (r=0.70, p<0.0001) in all patients. Thus, the peak atrial systolic pulmonary venous flow velocity corre-lated well with left atrial pressure changes during atrial systole. Furthermore, the sum of the time-velocity integral of the atrial systolic transmitral and pulmonary venous flow velocities correlated well with left atrial volume changes during atrial systole. Therefore, transesophageal echocardiographic measurements of atrial systolic transmitral and pulmonary venous flow velocities arereasonable indicators of left atrial pressure and volume changes during atrial systole.
