The Experts below are selected from a list of 126 Experts worldwide ranked by ideXlab platform
Massimo Pozzoli - One of the best experts on this subject based on the ideXlab platform.
-
Pulmonary venous flow in patients with chronic heart failure: feasibility and additional value compared to transmitral flow for non-invasive estimation of Pulmonary Wedge Pressure
Giornale italiano di cardiologia, 1996Co-Authors: Capomolla S, Massimo Pozzoli, Gola A, Maestri R, Sisti M, Franco Cobelli, Luigi TavazziAbstract:BACKGROUND In many cardiac conditions, Doppler of transmitral flow has been showed to be related to left ventricular filling Pressure, but several factors may limit its practical value in estimating Pulmonary Wedge Pressure in patients with chronic heart failure. Pulmonary venous velocities directly depend on the oscillations of left atrial Pressure. Recent studies suggest that transthoracic Doppler of Pulmonary venous flow provides a more accurate estimation of Pulmonary Wedge Pressure. However the relative values of transmitral and Pulmonary venous flow for assessing Pulmonary Wedge Pressure in patients with chronic heart failure have not been fully classified until now. Accordingly, we performed this study to assess the feasibility of transthoracic Doppler of Pulmonary venous flow in patients with chronic heart failure and to evaluate whether it provides additional information regarding Pulmonary Wedge Pressure when compared with Doppler indices of transmitral flow. METHODS Simultaneous Doppler echocardiographic examinations and right heart catheterizations were performed prospectively in 300 consecutive patients with chronic heart failure due to dilated cardiomyopathy. The correlations of mitral and Pulmonary venous flow velocity variables, left atrial volumes, mitral regurgitation jet area and left ventricular ejection fraction with Pulmonary artery Wedge Pressure were evaluated. RESULTS A complete recording of transthoracic Pulmonary venous flow including all components was obtained in 66% of patients, while only systolic and diastolic forward flow were recorded in 88% of patients. Several indices, derived from Pulmonary venous flow, were correlated with Pulmonary Wedge Pressure; the strongest correlation was between systolic fraction of peak velocities and Pulmonary Wedge Pressure (r = -0.76). This value was similar to that obtained between deceleration rate (r = 0.78) and deceleration time (r = -0.67) of transmitral flow and Pulmonary Wedge Pressure. A systolic fraction > 40% showed a greater positive predictive value than restrictive pattern of transmitral flow for identifying patients with Pulmonary Wedge Pressure > 18 mmHg (95% vs 86% p < 0.05). This accuracy is confirmed also in patients who had a single peak of transmitral flow. CONCLUSIONS Doppler of Pulmonary venous flow can be performed in a high percentage of patients with chronic heart failure due to dilated cardiomyopathy. The indices derived from transthoracic Pulmonary venous flow are strongly correlated with Pulmonary Wedge Pressure and improve the noninvasive identification of patients with high Pulmonary Wedge Pressure, even when transmitral flow pattern is difficult to be interpreted.
-
Doppler evaluations of left ventricular diastolic filling and Pulmonary Wedge Pressure provide similar prognostic information in patients with systolic dysfunction after myocardial infarction.
American heart journal, 1995Co-Authors: Massimo Pozzoli, Franco Cobelli, Soccorso Capomolla, Maurizio Sanarico, G.d. Pinna, Luigi TavazziAbstract:Abstract Previous studies have demonstrated that in patients with various lypes of cardiac diseases and left ventricular dysfunction, left ventricular filling patterns assessed by Doppler of mitral flow are correlated to ventricular filling Pressure, the prognostic value of which is well known. The current study was carried out to determine the prognostic importance of a noninvasive evaluation of left ventricular filling by Doppler of mitral flow in patients with systolic dysfunction after myocardial infarction and to compare its value with that of Pulmonary Wedge Pressure. One hundred seven patients with a left ventricular ejection fraction >40% were studied 3 to 12 weeks after myocardial infarction. All patients underwent a complete clinical examination, a standard two-dimensional and Doppler echocardiographic examination, and right-sided heart catheterization at rest and during a cardioPulmonary bicycle exercise test. Early and late diastolic peak flow velocities, their ratio, and the deceleration time of early diastolic velocity were measured from pulsed-wave Doppler of mitral flow. Follow-up data were obtained for 101 patients. During a mean period of 25 (median 21, range 12 to 60) months cardiac events (death, heart transplantation, or heart failure requiring hospitalization) occurred in 43 (42%) patients. Patients with cardiac events during follow-up were in a worse functional class and had a more impaired exercise capacity and higher capillary Pulmonary Wedge Pressure at baseline examination. Among Doppler echocariodgraphic variables, in patients with cardiac events a greater early to late diastolic peak velocity ratio of mitral flow (1.9 ± 0.9 pl/min vs 1.2 ± 0.8 pl/min, p p 1 (64% in functional class I or II and 36% functional class III). Similar results were obtained when mean Pulmonary Wedge Pressure was considered instead of the ratio between peak flow velocities of mitral flow. The results of this study indicate that in patients with left ventricular systolic dysfunction and previous myocardial infarction, a predominant early diastolic left ventricular filling pattern is associated with an adverse outcome. In addition, left ventricular filling patterns evaluated by Doppler and mean Pulmonary Wedge Pressure provide similar prognostic information in these patients.
-
Left ventricular filling pattern and Pulmonary Wedge Pressure are closely related in patients with recent anterior myocardial infarction and left ventricular dysfunction.
European heart journal, 1992Co-Authors: Massimo Pozzoli, Franco Cobelli, Soccorso Capomolla, Cristina Opasich, R. Reggiani, G. Calsamiglia, L. TavazziAbstract:To determine whether mitral flow velocity can be used to estimate mean Pulmonary Wedge Pressure (PWP) in patients with left ventricular dysfunction, 50 patients with recent Q-wave anterior infarction and a reduced ejection fraction ( < 40% ) underwent simultaneous pulsed-wave Doppler measurements of mitral flow and right heart catheterization. Doppler tracings and PWP were recorded at rest, after passive leg lifting (45°) and (in 15 patients with increased PWP) after 5 mg sublingual ISDN. Significant correlations were found between the ratio of peak early to peak late diastolic velocity (EjA) and PWP (r = 0.83). Early diastolic deceleration and the ratio of the time velocity integral of atrial contribution to the total time velocity integral were also correlated to PWP (r 0.80 and r = 0.79 (respectively). The E/A ratio was less than 1 in 25 patients and more than 1 in the remaining 25. An E/A ratio of at least 1 predicted a PWP of more than 20 mmHg with a sensitivity of 100% and a specificity of 86%. In all five patients, in whom the P WP was less than 20 mmHg at baseline and became greater with leg lifting, the E/A ratio changed from less than 1 to more than L After ISDN, changes in E/A ratio from more than 1 to less than 1 identified all 12 patients with a PWP falling below 20 mmHg. In conclusion, patients with recent Q-wave anterior infarction and a reduced ejection fraction mitral flow velocity-derived variables correlate with PWP representing a reliable index for the diagnosis of markedly increased PWP. In individual patients, Doppler measurement of mitral flow can predict directional changes of PWP and may provide a simple non-invasive means of assessing the haemodynamic effect of therapeutic interventions.
Luigi Tavazzi - One of the best experts on this subject based on the ideXlab platform.
-
Pulmonary venous flow in patients with chronic heart failure: feasibility and additional value compared to transmitral flow for non-invasive estimation of Pulmonary Wedge Pressure
Giornale italiano di cardiologia, 1996Co-Authors: Capomolla S, Massimo Pozzoli, Gola A, Maestri R, Sisti M, Franco Cobelli, Luigi TavazziAbstract:BACKGROUND In many cardiac conditions, Doppler of transmitral flow has been showed to be related to left ventricular filling Pressure, but several factors may limit its practical value in estimating Pulmonary Wedge Pressure in patients with chronic heart failure. Pulmonary venous velocities directly depend on the oscillations of left atrial Pressure. Recent studies suggest that transthoracic Doppler of Pulmonary venous flow provides a more accurate estimation of Pulmonary Wedge Pressure. However the relative values of transmitral and Pulmonary venous flow for assessing Pulmonary Wedge Pressure in patients with chronic heart failure have not been fully classified until now. Accordingly, we performed this study to assess the feasibility of transthoracic Doppler of Pulmonary venous flow in patients with chronic heart failure and to evaluate whether it provides additional information regarding Pulmonary Wedge Pressure when compared with Doppler indices of transmitral flow. METHODS Simultaneous Doppler echocardiographic examinations and right heart catheterizations were performed prospectively in 300 consecutive patients with chronic heart failure due to dilated cardiomyopathy. The correlations of mitral and Pulmonary venous flow velocity variables, left atrial volumes, mitral regurgitation jet area and left ventricular ejection fraction with Pulmonary artery Wedge Pressure were evaluated. RESULTS A complete recording of transthoracic Pulmonary venous flow including all components was obtained in 66% of patients, while only systolic and diastolic forward flow were recorded in 88% of patients. Several indices, derived from Pulmonary venous flow, were correlated with Pulmonary Wedge Pressure; the strongest correlation was between systolic fraction of peak velocities and Pulmonary Wedge Pressure (r = -0.76). This value was similar to that obtained between deceleration rate (r = 0.78) and deceleration time (r = -0.67) of transmitral flow and Pulmonary Wedge Pressure. A systolic fraction > 40% showed a greater positive predictive value than restrictive pattern of transmitral flow for identifying patients with Pulmonary Wedge Pressure > 18 mmHg (95% vs 86% p < 0.05). This accuracy is confirmed also in patients who had a single peak of transmitral flow. CONCLUSIONS Doppler of Pulmonary venous flow can be performed in a high percentage of patients with chronic heart failure due to dilated cardiomyopathy. The indices derived from transthoracic Pulmonary venous flow are strongly correlated with Pulmonary Wedge Pressure and improve the noninvasive identification of patients with high Pulmonary Wedge Pressure, even when transmitral flow pattern is difficult to be interpreted.
-
Doppler evaluations of left ventricular diastolic filling and Pulmonary Wedge Pressure provide similar prognostic information in patients with systolic dysfunction after myocardial infarction.
American heart journal, 1995Co-Authors: Massimo Pozzoli, Franco Cobelli, Soccorso Capomolla, Maurizio Sanarico, G.d. Pinna, Luigi TavazziAbstract:Abstract Previous studies have demonstrated that in patients with various lypes of cardiac diseases and left ventricular dysfunction, left ventricular filling patterns assessed by Doppler of mitral flow are correlated to ventricular filling Pressure, the prognostic value of which is well known. The current study was carried out to determine the prognostic importance of a noninvasive evaluation of left ventricular filling by Doppler of mitral flow in patients with systolic dysfunction after myocardial infarction and to compare its value with that of Pulmonary Wedge Pressure. One hundred seven patients with a left ventricular ejection fraction >40% were studied 3 to 12 weeks after myocardial infarction. All patients underwent a complete clinical examination, a standard two-dimensional and Doppler echocardiographic examination, and right-sided heart catheterization at rest and during a cardioPulmonary bicycle exercise test. Early and late diastolic peak flow velocities, their ratio, and the deceleration time of early diastolic velocity were measured from pulsed-wave Doppler of mitral flow. Follow-up data were obtained for 101 patients. During a mean period of 25 (median 21, range 12 to 60) months cardiac events (death, heart transplantation, or heart failure requiring hospitalization) occurred in 43 (42%) patients. Patients with cardiac events during follow-up were in a worse functional class and had a more impaired exercise capacity and higher capillary Pulmonary Wedge Pressure at baseline examination. Among Doppler echocariodgraphic variables, in patients with cardiac events a greater early to late diastolic peak velocity ratio of mitral flow (1.9 ± 0.9 pl/min vs 1.2 ± 0.8 pl/min, p p 1 (64% in functional class I or II and 36% functional class III). Similar results were obtained when mean Pulmonary Wedge Pressure was considered instead of the ratio between peak flow velocities of mitral flow. The results of this study indicate that in patients with left ventricular systolic dysfunction and previous myocardial infarction, a predominant early diastolic left ventricular filling pattern is associated with an adverse outcome. In addition, left ventricular filling patterns evaluated by Doppler and mean Pulmonary Wedge Pressure provide similar prognostic information in these patients.
Franco Cobelli - One of the best experts on this subject based on the ideXlab platform.
-
Pulmonary venous flow in patients with chronic heart failure: feasibility and additional value compared to transmitral flow for non-invasive estimation of Pulmonary Wedge Pressure
Giornale italiano di cardiologia, 1996Co-Authors: Capomolla S, Massimo Pozzoli, Gola A, Maestri R, Sisti M, Franco Cobelli, Luigi TavazziAbstract:BACKGROUND In many cardiac conditions, Doppler of transmitral flow has been showed to be related to left ventricular filling Pressure, but several factors may limit its practical value in estimating Pulmonary Wedge Pressure in patients with chronic heart failure. Pulmonary venous velocities directly depend on the oscillations of left atrial Pressure. Recent studies suggest that transthoracic Doppler of Pulmonary venous flow provides a more accurate estimation of Pulmonary Wedge Pressure. However the relative values of transmitral and Pulmonary venous flow for assessing Pulmonary Wedge Pressure in patients with chronic heart failure have not been fully classified until now. Accordingly, we performed this study to assess the feasibility of transthoracic Doppler of Pulmonary venous flow in patients with chronic heart failure and to evaluate whether it provides additional information regarding Pulmonary Wedge Pressure when compared with Doppler indices of transmitral flow. METHODS Simultaneous Doppler echocardiographic examinations and right heart catheterizations were performed prospectively in 300 consecutive patients with chronic heart failure due to dilated cardiomyopathy. The correlations of mitral and Pulmonary venous flow velocity variables, left atrial volumes, mitral regurgitation jet area and left ventricular ejection fraction with Pulmonary artery Wedge Pressure were evaluated. RESULTS A complete recording of transthoracic Pulmonary venous flow including all components was obtained in 66% of patients, while only systolic and diastolic forward flow were recorded in 88% of patients. Several indices, derived from Pulmonary venous flow, were correlated with Pulmonary Wedge Pressure; the strongest correlation was between systolic fraction of peak velocities and Pulmonary Wedge Pressure (r = -0.76). This value was similar to that obtained between deceleration rate (r = 0.78) and deceleration time (r = -0.67) of transmitral flow and Pulmonary Wedge Pressure. A systolic fraction > 40% showed a greater positive predictive value than restrictive pattern of transmitral flow for identifying patients with Pulmonary Wedge Pressure > 18 mmHg (95% vs 86% p < 0.05). This accuracy is confirmed also in patients who had a single peak of transmitral flow. CONCLUSIONS Doppler of Pulmonary venous flow can be performed in a high percentage of patients with chronic heart failure due to dilated cardiomyopathy. The indices derived from transthoracic Pulmonary venous flow are strongly correlated with Pulmonary Wedge Pressure and improve the noninvasive identification of patients with high Pulmonary Wedge Pressure, even when transmitral flow pattern is difficult to be interpreted.
-
Doppler evaluations of left ventricular diastolic filling and Pulmonary Wedge Pressure provide similar prognostic information in patients with systolic dysfunction after myocardial infarction.
American heart journal, 1995Co-Authors: Massimo Pozzoli, Franco Cobelli, Soccorso Capomolla, Maurizio Sanarico, G.d. Pinna, Luigi TavazziAbstract:Abstract Previous studies have demonstrated that in patients with various lypes of cardiac diseases and left ventricular dysfunction, left ventricular filling patterns assessed by Doppler of mitral flow are correlated to ventricular filling Pressure, the prognostic value of which is well known. The current study was carried out to determine the prognostic importance of a noninvasive evaluation of left ventricular filling by Doppler of mitral flow in patients with systolic dysfunction after myocardial infarction and to compare its value with that of Pulmonary Wedge Pressure. One hundred seven patients with a left ventricular ejection fraction >40% were studied 3 to 12 weeks after myocardial infarction. All patients underwent a complete clinical examination, a standard two-dimensional and Doppler echocardiographic examination, and right-sided heart catheterization at rest and during a cardioPulmonary bicycle exercise test. Early and late diastolic peak flow velocities, their ratio, and the deceleration time of early diastolic velocity were measured from pulsed-wave Doppler of mitral flow. Follow-up data were obtained for 101 patients. During a mean period of 25 (median 21, range 12 to 60) months cardiac events (death, heart transplantation, or heart failure requiring hospitalization) occurred in 43 (42%) patients. Patients with cardiac events during follow-up were in a worse functional class and had a more impaired exercise capacity and higher capillary Pulmonary Wedge Pressure at baseline examination. Among Doppler echocariodgraphic variables, in patients with cardiac events a greater early to late diastolic peak velocity ratio of mitral flow (1.9 ± 0.9 pl/min vs 1.2 ± 0.8 pl/min, p p 1 (64% in functional class I or II and 36% functional class III). Similar results were obtained when mean Pulmonary Wedge Pressure was considered instead of the ratio between peak flow velocities of mitral flow. The results of this study indicate that in patients with left ventricular systolic dysfunction and previous myocardial infarction, a predominant early diastolic left ventricular filling pattern is associated with an adverse outcome. In addition, left ventricular filling patterns evaluated by Doppler and mean Pulmonary Wedge Pressure provide similar prognostic information in these patients.
-
Left ventricular filling pattern and Pulmonary Wedge Pressure are closely related in patients with recent anterior myocardial infarction and left ventricular dysfunction.
European heart journal, 1992Co-Authors: Massimo Pozzoli, Franco Cobelli, Soccorso Capomolla, Cristina Opasich, R. Reggiani, G. Calsamiglia, L. TavazziAbstract:To determine whether mitral flow velocity can be used to estimate mean Pulmonary Wedge Pressure (PWP) in patients with left ventricular dysfunction, 50 patients with recent Q-wave anterior infarction and a reduced ejection fraction ( < 40% ) underwent simultaneous pulsed-wave Doppler measurements of mitral flow and right heart catheterization. Doppler tracings and PWP were recorded at rest, after passive leg lifting (45°) and (in 15 patients with increased PWP) after 5 mg sublingual ISDN. Significant correlations were found between the ratio of peak early to peak late diastolic velocity (EjA) and PWP (r = 0.83). Early diastolic deceleration and the ratio of the time velocity integral of atrial contribution to the total time velocity integral were also correlated to PWP (r 0.80 and r = 0.79 (respectively). The E/A ratio was less than 1 in 25 patients and more than 1 in the remaining 25. An E/A ratio of at least 1 predicted a PWP of more than 20 mmHg with a sensitivity of 100% and a specificity of 86%. In all five patients, in whom the P WP was less than 20 mmHg at baseline and became greater with leg lifting, the E/A ratio changed from less than 1 to more than L After ISDN, changes in E/A ratio from more than 1 to less than 1 identified all 12 patients with a PWP falling below 20 mmHg. In conclusion, patients with recent Q-wave anterior infarction and a reduced ejection fraction mitral flow velocity-derived variables correlate with PWP representing a reliable index for the diagnosis of markedly increased PWP. In individual patients, Doppler measurement of mitral flow can predict directional changes of PWP and may provide a simple non-invasive means of assessing the haemodynamic effect of therapeutic interventions.
L. Tavazzi - One of the best experts on this subject based on the ideXlab platform.
-
Left ventricular filling pattern and Pulmonary Wedge Pressure are closely related in patients with recent anterior myocardial infarction and left ventricular dysfunction.
European heart journal, 1992Co-Authors: Massimo Pozzoli, Franco Cobelli, Soccorso Capomolla, Cristina Opasich, R. Reggiani, G. Calsamiglia, L. TavazziAbstract:To determine whether mitral flow velocity can be used to estimate mean Pulmonary Wedge Pressure (PWP) in patients with left ventricular dysfunction, 50 patients with recent Q-wave anterior infarction and a reduced ejection fraction ( < 40% ) underwent simultaneous pulsed-wave Doppler measurements of mitral flow and right heart catheterization. Doppler tracings and PWP were recorded at rest, after passive leg lifting (45°) and (in 15 patients with increased PWP) after 5 mg sublingual ISDN. Significant correlations were found between the ratio of peak early to peak late diastolic velocity (EjA) and PWP (r = 0.83). Early diastolic deceleration and the ratio of the time velocity integral of atrial contribution to the total time velocity integral were also correlated to PWP (r 0.80 and r = 0.79 (respectively). The E/A ratio was less than 1 in 25 patients and more than 1 in the remaining 25. An E/A ratio of at least 1 predicted a PWP of more than 20 mmHg with a sensitivity of 100% and a specificity of 86%. In all five patients, in whom the P WP was less than 20 mmHg at baseline and became greater with leg lifting, the E/A ratio changed from less than 1 to more than L After ISDN, changes in E/A ratio from more than 1 to less than 1 identified all 12 patients with a PWP falling below 20 mmHg. In conclusion, patients with recent Q-wave anterior infarction and a reduced ejection fraction mitral flow velocity-derived variables correlate with PWP representing a reliable index for the diagnosis of markedly increased PWP. In individual patients, Doppler measurement of mitral flow can predict directional changes of PWP and may provide a simple non-invasive means of assessing the haemodynamic effect of therapeutic interventions.
-
Effects of mental exercise in patients with dilated cardiomyopathy and congestive heart failure. An echocardiographic Doppler study.
Circulation, 1991Co-Authors: P Giannuzzi, R Shabetai, A Imparato, P L Temporelli, V Bhargava, R Cremo, L. TavazziAbstract:To assess the effects of mental stress on left ventricular diastolic function in patients with congestive heart failure, nine patients aged 57 +/- 12 years with dilated cardiomyopathy (end-diastolic volume, more than 110 ml/m2; ejection fraction, less than 40%; mean, 28 +/- 8%) and congestive heart failure in New York Heart Association functional class II or III and 14 normal volunteers (mean age, 49 +/- 8 years) were studied during mental arithmetic lasting 10 minutes with echocardiographic Doppler monitoring of transmitral flow velocity. During mental arithmetic, the ratio of peak flow velocity in early versus late diastole (E/A) and deceleration time of early diastole did not change in normal controls. However, E/A increased significantly (from 1.6 +/- 1.5 to 1.9 +/- 1.7; p less than 0.01) and deceleration time markedly decreased (from 156 +/- 49 to 108 +/- 31 msec; p less than 0.001) in patients with congestive heart failure. In 16 postinfarct patients with ejection fraction of less than 40% studied during mental arithmetic with simultaneous hemodynamics and Doppler recordings, good correlations were found between Pulmonary Wedge Pressure and Doppler parameters (Wedge Pressure versus E/A, r = 0.89; Wedge Pressure versus deceleration time, r = -0.87). During mental arithmetic, the Pulmonary Wedge Pressure-E/A correlation was weaker (r = 0.67), whereas the correlation between Pulmonary Wedge Pressure and deceleration time was stronger (r = 0.91). The value of 153 msec in deceleration time was the best cutoff point in predicting 12 mm Hg Pulmonary Wedge Pressure, both at rest and during mental arithmetic: the higher the deceleration time, the lower the Pulmonary Wedge Pressure, and vice versa. Among patients with congestive heart failure, five showed normal baseline deceleration time (195 +/- 21 msec; pattern 1), and the remaining four showed a short (less than 153 msec) deceleration time (108 +/- 13 msec; pattern 2). During mental arithmetic, deceleration time markedly decreased to as short as 119 +/- 20 msec in all patients except one with baseline pattern 1. Deceleration time further decreased to 75 +/- 6 msec in all patients with baseline pattern 2. Mental arithmetic induces changes in left ventricular diastolic function in patients with congestive heart failure. Transmitral echocardiographic Doppler provides a simple noninvasive method of estimating and monitoring Pulmonary Wedge Pressure in patients with severe left ventricular dysfunction.
Soccorso Capomolla - One of the best experts on this subject based on the ideXlab platform.
-
Doppler evaluations of left ventricular diastolic filling and Pulmonary Wedge Pressure provide similar prognostic information in patients with systolic dysfunction after myocardial infarction.
American heart journal, 1995Co-Authors: Massimo Pozzoli, Franco Cobelli, Soccorso Capomolla, Maurizio Sanarico, G.d. Pinna, Luigi TavazziAbstract:Abstract Previous studies have demonstrated that in patients with various lypes of cardiac diseases and left ventricular dysfunction, left ventricular filling patterns assessed by Doppler of mitral flow are correlated to ventricular filling Pressure, the prognostic value of which is well known. The current study was carried out to determine the prognostic importance of a noninvasive evaluation of left ventricular filling by Doppler of mitral flow in patients with systolic dysfunction after myocardial infarction and to compare its value with that of Pulmonary Wedge Pressure. One hundred seven patients with a left ventricular ejection fraction >40% were studied 3 to 12 weeks after myocardial infarction. All patients underwent a complete clinical examination, a standard two-dimensional and Doppler echocardiographic examination, and right-sided heart catheterization at rest and during a cardioPulmonary bicycle exercise test. Early and late diastolic peak flow velocities, their ratio, and the deceleration time of early diastolic velocity were measured from pulsed-wave Doppler of mitral flow. Follow-up data were obtained for 101 patients. During a mean period of 25 (median 21, range 12 to 60) months cardiac events (death, heart transplantation, or heart failure requiring hospitalization) occurred in 43 (42%) patients. Patients with cardiac events during follow-up were in a worse functional class and had a more impaired exercise capacity and higher capillary Pulmonary Wedge Pressure at baseline examination. Among Doppler echocariodgraphic variables, in patients with cardiac events a greater early to late diastolic peak velocity ratio of mitral flow (1.9 ± 0.9 pl/min vs 1.2 ± 0.8 pl/min, p p 1 (64% in functional class I or II and 36% functional class III). Similar results were obtained when mean Pulmonary Wedge Pressure was considered instead of the ratio between peak flow velocities of mitral flow. The results of this study indicate that in patients with left ventricular systolic dysfunction and previous myocardial infarction, a predominant early diastolic left ventricular filling pattern is associated with an adverse outcome. In addition, left ventricular filling patterns evaluated by Doppler and mean Pulmonary Wedge Pressure provide similar prognostic information in these patients.
-
Left ventricular filling pattern and Pulmonary Wedge Pressure are closely related in patients with recent anterior myocardial infarction and left ventricular dysfunction.
European heart journal, 1992Co-Authors: Massimo Pozzoli, Franco Cobelli, Soccorso Capomolla, Cristina Opasich, R. Reggiani, G. Calsamiglia, L. TavazziAbstract:To determine whether mitral flow velocity can be used to estimate mean Pulmonary Wedge Pressure (PWP) in patients with left ventricular dysfunction, 50 patients with recent Q-wave anterior infarction and a reduced ejection fraction ( < 40% ) underwent simultaneous pulsed-wave Doppler measurements of mitral flow and right heart catheterization. Doppler tracings and PWP were recorded at rest, after passive leg lifting (45°) and (in 15 patients with increased PWP) after 5 mg sublingual ISDN. Significant correlations were found between the ratio of peak early to peak late diastolic velocity (EjA) and PWP (r = 0.83). Early diastolic deceleration and the ratio of the time velocity integral of atrial contribution to the total time velocity integral were also correlated to PWP (r 0.80 and r = 0.79 (respectively). The E/A ratio was less than 1 in 25 patients and more than 1 in the remaining 25. An E/A ratio of at least 1 predicted a PWP of more than 20 mmHg with a sensitivity of 100% and a specificity of 86%. In all five patients, in whom the P WP was less than 20 mmHg at baseline and became greater with leg lifting, the E/A ratio changed from less than 1 to more than L After ISDN, changes in E/A ratio from more than 1 to less than 1 identified all 12 patients with a PWP falling below 20 mmHg. In conclusion, patients with recent Q-wave anterior infarction and a reduced ejection fraction mitral flow velocity-derived variables correlate with PWP representing a reliable index for the diagnosis of markedly increased PWP. In individual patients, Doppler measurement of mitral flow can predict directional changes of PWP and may provide a simple non-invasive means of assessing the haemodynamic effect of therapeutic interventions.
