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Tissue Doppler echocardiographic and color M-mode estimation of left atrial pressure in infants
Fabrice Larrazet1, Kamel Bouabdallah, Emmanuel Le Bret
1Department of Cardiology, Institut Mutualiste Montsouris, Paris, France.
Insights
Doppler ratios, including E/Ea and E/Vp, show promise for noninvasively assessing left atrial pressure in infants post-cardiac surgery. These measurements can help evaluate hemodynamic status in critically ill children.
Area of Science:
- Pediatric Cardiology
- Echocardiography
- Critical Care Medicine
Background:
- Accurate assessment of left atrial pressure (LAP) is crucial for managing infants after congenital heart disease surgery.
- Current invasive methods carry risks, necessitating the exploration of noninvasive alternatives.
Purpose of the Study:
- To evaluate the relationship between Doppler-derived ratios (E/Ea and E/Vp) and mean LAP in infants following cardiac surgery.
- To determine the diagnostic accuracy of these ratios for identifying elevated LAP.
Main Methods:
- A prospective study involving 37 infants post-cardiac surgery in a pediatric intensive care unit.
- Simultaneous Doppler echocardiography and invasive hemodynamic monitoring were performed.
- Analysis of peak early transmitral flow velocity (E)/early diastolic mitral annular velocity (Ea) and E/flow propagation velocity (Vp) ratios.
Main Results:
- Both E/Ea and E/Vp ratios were significantly higher in infants with LAP >10 mm Hg.
- E/Vp demonstrated higher sensitivity (83%) and specificity (89%) at a cutoff of 2 compared to E/Ea (94% sensitivity, 72% specificity at a cutoff of 15).
- Areas under the ROC curves were 0.76 for E/Ea and 0.83 for E/Vp, indicating good diagnostic performance.
Conclusions:
- Doppler-derived E/Ea and E/Vp ratios are potential noninvasive markers for evaluating LAP in infants after cardiac surgery.
- These echocardiographic parameters may aid in the hemodynamic assessment of this vulnerable patient population.
Objectives:
Using recorded flow and tissue Doppler, we evaluated the relation of peak velocity of early transmitral Doppler filling (E)/early diastolic velocity of the lateral mitral annulus (Ea) ratio and of E/flow propagation velocity (Vp) ratio to mean left atrial pressure in infants after surgery for congenital heart disease.
Design:
Experimental design.
Setting:
Pediatric intensive care unit.
Patients:
Thirty-seven infants aged 4 (3-8) months.
Interventions:
Patients underwent postoperative invasive hemodynamic monitoring with simultaneously obtained Doppler measurements.
Measurements And Main Results:
Values are expressed as median (25th-75th percentiles). Heart rate was 145 (135-157) beats/min. Left atrial pressure was 10 (8-12) mm Hg with E/Ea 16 (12-19) and E/Vp 1.9 (1.3-2.4). E/Ea and E/Vp ratios were higher in patients with left atrial pressure >10 mm Hg (n = 18), than in patients with left atrial pressure < or =10 mm Hg (n = 19) (E/Ea, 16 [15-25] vs. 12 [9-17], p = .01; E/Vp, 2.3 [1.9-2.8] vs. 1.4 [1-1.9]. respectively, p = .001). At a cutoff point of 15, E/Ea sensitivity for left atrial pressure >10 mm Hg was 17 of 18 (94%) with specificity 13 of 18 (72%). At a cutoff point of 2, E/Vp sensitivity for left atrial pressure >10 mm Hg was 15 of 18 (83%) with specificity 16 of 18 (89%). Areas under the receiver operating characteristic curves were 0.76 (E/Ea) and 0.83 (E/Vp).
Conclusions:
Doppler ratios might be considered as promising noninvasive tools for left atrial pressure evaluation in infants after cardiac surgery.
