Abstract
Assessing left ventricular (LV) filling pressure (pulmonary capillary wedge pressure, PCWP) is essential in the care of patients with heart failure (HF). Physicians use right ventricular (RV) filling pressure such as central venous pressure (CVP) to predict PCWP. However, the use of this method is limited because discordance between CVP and PCWP is sometimes observed. Our theoretical analysis indicated that PCWP can be predicted by CVP corrected by the relation between RV and LV function, provided by the ratio of tissue-Doppler systolic velocity of tricuspid annulus (ST) to that of mitral annulus (SM) (CVP·ST/SM). In 16 HF dogs, a stronger correlation was observed between CVP·ST/SM and PCWP than between CVP and PCWP. This was also confirmed in 98 HF patients. Furthermore, when ultrasonic dimension of inferior vena cava (IVCD) was used as a noninvasive alternative to CVP in the HF patients, a stronger correlation was observed between IVCD·ST/SM and PCWP than between the early diastolic transmitral inflow to mitral annular velocity ratio (E/e') and PCWP. RV filling pressure or its noninvasive surrogate such as IVCD corrected by ST/SM may be useful to predict PCWP in HF patients.
