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Shortened Doppler-derived mitral A wave deceleration time: an important predictor of elevated left ventricular
1Heart Institute, Sheba Medical Center, Tel Aviv, Israel.
Insights
A shortened mitral inflow A wave deceleration time can identify elevated left ventricular filling pressures. This Doppler measurement offers a valuable, non-invasive method for assessing cardiac function in patients.
Area of Science:
- Cardiology
- Echocardiography
- Hemodynamics
Background:
- Elevated left ventricular end-diastolic pressure can cause rapid increases in left ventricular pressure, exceeding left atrial pressure.
- This pressure gradient leads to an abrupt halt in the A wave of mitral inflow.
- A shortened A wave deceleration time may indicate elevated end-diastolic pressure.
Purpose of the Study:
- To determine if A wave deceleration time, a novel mitral inflow variable, can identify patients with increased left ventricular filling pressures.
- To establish the diagnostic utility of A wave deceleration time in assessing elevated filling pressures.
Main Methods:
- Pulsed Doppler mitral inflow velocities were recorded in 44 cardiac catheterization patients and 15 healthy volunteers.
- Measurements included capillary wedge pressure and left ventricular end-diastolic pressure.
- Analysis focused on correlations between A wave deceleration time and hemodynamic parameters.
Main Results:
- A wave deceleration time strongly correlated with mean pulmonary wedge pressure (r = -0.87) and left ventricular end-diastolic pressure (r = -0.74).
- A wave deceleration time ≤ 60 ms accurately predicted elevated pressures (> 18 mm Hg) with high sensitivity and 100% specificity.
- Modest correlations were observed for other Doppler variables like peak E/A and E wave deceleration time.
Conclusions:
- A shortened Doppler mitral inflow A wave deceleration time is a valuable indicator of elevated left ventricular filling pressure.
- This finding suggests a potential non-invasive method for assessing diastolic dysfunction and filling pressures.
Objectives:
The aim of this study was to investigate whether a new variable of mitral inflow, A wave deceleration time, identifies patients with elevated left ventricular filling pressures.
Background:
In patients with an elevated left ventricular end-diastolic pressure, the increase in left ventricular pressure after atrial contraction rapidly exceeds left atrial pressure, resulting in abrupt cessation of the A wave. Therefore, we postulated that a shortening of A wave deceleration time might be a marker for elevated end-diastolic pressure.
Methods:
Adequate pulsed Doppler mitral inflow velocities could be recorded in 40 of 44 consecutive patients undergoing cardiac catheterization with capillary wedge pressure in 20 patients, and within 1 h after left ventricular end-diastolic pressure recording in 20. Fifteen healthy volunteers were also studied.
Results:
Left ventricular end-diastolic pressure was 8 to 35 mm Hg, and mean pulmonary wedge pressure was 6 to 37 mm Hg. Close correlations were found between A wave deceleration time and mean pulmonary wedge pressure (r = -0.87) and left ventricular end-diastolic pressure (r = -0.74). There were modest correlations between both pressures and peak E/A, E wave deceleration time and A wave duration, respectively; r = 0.59, -0.30 and -0.58 for capillary wedge and r = 0.25, -0.38 and -0.49 for end-diastolic pressures. A wave deceleration time 18 mm Hg, respectively, with a sensitivity of 67% and 89% and specificity of 100% for both.
Conclusions:
A shortened Doppler mitral inflow A wave deceleration time is a useful index of elevated left ventricular filling pressure.