Assessment of left ventricular filling pressures by Doppler in the presence of atrial fibrillation

Abstract

Background: Although Doppler echocardiography can be used to estimate left ventricular filling pressures (LVFPs) in patients in sinus rhythm, its utility in atrial fibrillation is unknown.

Methods and results: An initial training population of 30 patients (17 men, 13 women: mean age, 69 +/- 9 years; range, 48 to 87 years) was studied. Measurements of LVFP were obtained simultaneously with pulsed Doppler recordings of mitral and pulmonary venous flow velocities and color M-mode recording of the flow propagation velocity of the mitral inflow. Measurements were averaged over 10 cardiac cycles. In addition, left atrial volume was derived from the apical four-chamber view. Significant relations were observed between LVFP and several parameters derived from the transmitral and pulmonary venous velocity and left atrial volume. The best relations were observed with the peak acceleration (PkAcc) of the mitral velocity (r = .84), isovolumic relaxation time (IVRT) (r = .76), mean early (E) velocity (r = .6), and the ratio of peak E velocity to color M-mode flow propagation velocity (r = .65). The best model obtained by multilinear regression analysis (r = .88) included PkAcc and IVRT. The equation LVFP = 22+0.005 (PkAcc)-0.183(IVRT) was tested in 30 additional patients (12 women and 18 men: mean age, 65 +/- 10.6 years; range, 43 to 87 years) with similar results (r = .87). When all 60 patients were combined, the mean +/- ISD difference between predicted and observed pressure was -0.88 +/- 3.6 mm Hg.

Conclusions: LVFPs can be estimated with Doppler echocardiography in patients with atrial fibrillation.