The deceleration time of pulmonary venous diastolic flow is more accurate than the pulmonary artery occlusion pressure in predicting left atrial pressure

OBJECTIVES This study compared a prediction of mean left atrial pressure (PLA) ascertained by Doppler echocardiography of pulmonary venous flow (PVF), with predicted PLA using the pulmonary artery occlusion pressure (PAO). BACKGROUND In select patient groups, PVF variables correlate with PAO, an indirect measure of PLA. METHODS In 93 patients undergoing cardiac surgery, we recorded with transesophageal echocardiography mitral valve early (E) and late (A) wave velocities, deceleration time (DT) of E (DTE), and pulmonary vein systolic (S) and diastolic (D) wave velocities, DT of D (DTD) and systolic fraction. The Pimage was measured using a pulmonary artery catheter zeroed to midaxillary level. A further catheter was held at midatrial level to zero a transducer and was then inserted into the left atrium. A prediction rule for PLA from DTD was developed in 50 patients and applied prospectively to estimate PLA in 43 patients. RESULTS A close correlation (r = −0.92) was found between Pimage and DTimage. Systolic fraction (r = −0.63), DTE(r = −0.61), D wave (r = 0.57), E wave (r = 0.52), and E/A ratio (r = 0.13) correlated less closely with PLA. The mean difference between predicted and measured PLA was 0.58 mm Hg for DTD method and 1.72 mm Hg for Pimage, with limits of agreement (mean ± 2 SE) of −2.94 to 4.10 mm Hg and −2.48 to 5.92 mm Hg, respectively. A DTD of <175 ms had 100% sensitivity and 94% specificity for a PLA of >17 mm Hg. CONCLUSIONS Deceleration time of pulmonary vein diastolic wave is more accurate than PPAO in estimating left atrial pressure in cardiac surgical patients.