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Continuous Venous-Arterial Doppler Ultrasound During a Preload Challenge
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Preload-dependent variation of the propagation velocity in patients with congestive heart failure

Yoshihiro Seo1, Toshiyuki Ishimitsu, Tomoko Ishizu

  • 1Department of Internal Medicine, Ibaraki Seinan Medical Center Hospital, Sakai, Ibaraki, Japan. seo@bf6.so-net.ne.jp

Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography
|May 4, 2004
PubMed

Insights

Propagation velocity (Vp) in congestive heart failure (CHF) patients decreases as pulmonary capillary wedge pressure lowers with treatment. This preload-dependent variation in Vp should be considered during CHF patient assessments.

Area of Science:

  • Cardiology
  • Echocardiography
  • Hemodynamics

Background:

  • Color Doppler M-mode propagation velocity (Vp) is generally considered preload-independent.
  • However, its variation with dynamic preload changes in clinical settings, particularly in congestive heart failure (CHF) patients, remains unevaluated.
  • Left ventricular filling pressure significantly fluctuates during CHF treatment.

Purpose of the Study:

  • To investigate the hypothesis that preload-dependent variations in Vp occur during the treatment of CHF.
  • To evaluate the relationship between changes in Vp and hemodynamic parameters, specifically pulmonary capillary wedge pressure, in CHF patients undergoing therapy.

Main Methods:

  • Doppler echocardiography and hemodynamic evaluations were conducted in 24 CHF patients.
  • Data were collected at baseline presentation and after improvement with therapy (second study).
  • Stepwise linear regression analysis was used to identify predictors of Vp change.

Main Results:

  • Vp significantly decreased from 41 ± 5 cm/s at baseline to 28 ± 5 cm/s in the second study (P <.0001).
  • The change in pulmonary capillary wedge pressure (-8.3 ± 3.3 mm Hg) was the sole independent predictor of the change in Vp (-12.5 ± 5.9 cm/s) (r = 0.68, P =.0002).
  • The interval between studies was 48.6 ± 21.5 hours.

Conclusions:

  • Vp significantly decreases with reductions in pulmonary capillary wedge pressure during CHF treatment.
  • The observed preload-dependent variation in Vp necessitates consideration in clinical assessments of CHF patients.
  • These findings highlight the dynamic nature of Vp in response to hemodynamic changes in heart failure.
Abstract

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