[Left ventricular filling behavior in stress-induced myocardial ischemia--correlation between Doppler echocardiography determined transmitral flow profile and pulmonary capillary pressure]
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H Völler1, C Spielberg, K Schröder
1Abteilung für Kardiologie und Pulmologie im Klinikum, Freien Universität Berlin.
Insights
Doppler-derived transmitral filling patterns during exercise can indicate elevated filling pressures in patients with myocardial ischemia. An E/A-ratio greater than 1 reliably predicts pulmonary capillary wedge pressure exceeding 20 mm Hg.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Hemodynamics
Background:
- The impact of myocardial ischemia on Doppler-derived transmitral filling patterns remains debated.
- The influence of filling pressure on these patterns requires further investigation.
Purpose of the Study:
- To assess the relationship between transmitral flow profiles and pulmonary capillary wedge pressure (PC) in patients with exercise-induced myocardial ischemia.
- To determine if Doppler-derived parameters can predict elevated filling pressures.
Main Methods:
- Simultaneous measurement of Doppler-derived transmitral filling patterns and PC in 35 patients at rest and during exercise.
- Patients were categorized into two groups based on PC levels (<20 mm Hg and >=20 mm Hg).
Main Results:
- Correlation between PC and transmitral flow patterns improved at maximal workload, especially atrial contribution (r = -0.79) and E/A ratio (r = 0.74).
- Group 2 (PC >= 20 mm Hg) exhibited an E/A-ratio > 1 (1.61 m/s), distinct from Group 1 (PC < 20 mm Hg) with E/A-ratio < 1 (0.9 m/s) (p < 0.001).
Conclusions:
- Exercise-induced myocardial ischemia alters Doppler-derived transmitral flow patterns based on filling pressure.
- An E/A-ratio > 1 is a dependable indicator for predicting pulmonary capillary wedge pressure above 20 mm Hg.
Abstract:
The way Doppler-derived transmitral filling patterns are changed because of myocardial ischemia is controversial. Furthermore, the influence of the filling pressure has not been investigated sufficiently. To evaluate the relationship between transmitral flow profile and pulmonary capillary wedge pressure (PC), 35 patients with exercise-induced myocardial ischemia were examined. Both Doppler-derived transmitral filling patterns and PC were determined simultaneously at rest and during three stages of supine bicycle exercise. Patients were subdivided into two groups according to the hemodynamic response (group 1 = PC < 20 mm Hg; n = 10, and group 2 = PC > or = 20 mm Hg; n = 25). The correlation between PC and transmitral filling patterns was low at rest for all patients, but improved at maximal workload, particularly for the atrial contribution (r = -0.79), as well as the ratio of maximal and integrated early to late diastolic flow velocities (rE/A = 0.74; rEi/Ai = 0.72). Both groups revealed different flow profiles in regard to the hemodynamic response. While group 1 showed an E/A-ratio < 1, an E/A-ratio > 1 was registered in group 2 (0.9 m/s versus 1.61 m/s; p < 0.001). Exercise-induced myocardial ischemia lead to different Doppler-derived transmitral flow patterns with regard to the filling pressure. The relationship to the pulmonary capillary wedge pressure is so close that an E/A-ratio > 1 is a reliable parameter to predict a filling pressure > 20 mm Hg.