Abstract:
BACKGROUND:Pulmonary capillary wedge pressure (PCWP) is a useful index of preload and an important determinant of cardiac function. HYPOTHESIS:We postulated that the rate of blood propagating into the left atrium (LAIF-PR) would be a useful measure of PCWP in critically ill patients. METHODS:Fifty-two critically ill patients (36 men/16 women) receiving mechanical ventilation were studied by multiplane transesophageal echocardiography (TEE). Left atrial inflow propagation rate was measured in systole and diastole as the slope of the color M-mode signal entering the left atrium from the right upper pulmonic vein. RESULTS:Systolic and diastolic LAIF-PRs were feasible in 49 and 44 patients, respectively. Mean (+/- 1 standard deviation) LAIF-PR in systole was 40 +/- 26 cm/s (range 11-132) and in diastole 34 +/- 22 cm/s (range 5-102). Negative correlations with PCWP (mean 19 +/- 9 mmHg; range 3-40) were good for LAIF-PR in systole (r = -0.71, standard error of estimate [SEE] = 6 mmHg; p < 0.0001) and diastole (r = -0.71, SEE = 6 mmHg; p < 0.0001). Mean ejection fraction was 52 +/- 22% (range 15-88) and cardiac output was 6.97 +/- 3.52 l/min (range 2.26-17.93). Multivariate regression showed PCWP as the only independent predictor of systolic (p < 0.0001) and diastolic (p < 0.0001) LAIF-PR among age, heart rate, cardiac output, ejection fraction, or left atrial diameter. CONCLUSIONS:Left atrial inflow propagation rate derived by color M-mode TEE aligned with the right upper pulmonic vein is a promising new index of preload. Future studies addressing the determinants of LAIF-PR, such as left atrial compliance, are needed.
journal_name
Clin Cardioljournal_title
Clinical cardiologyauthors
Stoddard MF,Calzada N,Longaker RAdoi
10.1002/clc.4960260412subject
Has Abstractpub_date
2003-04-01 00:00:00pages
201-4issue
4eissn
0160-9289issn
1932-8737journal_volume
26pub_type
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