Skip to main content

Advertisement

SpringerLink
Log in

Contemporary usefulness of pulmonary venous flow parameters to estimate left ventricular end-diastolic pressure on transthoracic echocardiography

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

Measurement of pulmonary venous flow (PVF) parameters can be used to estimate left ventricular end-diastolic pressure (LVEDP) on transthoracic echocardiography. Despite that, 2016 American Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging (EACVI) algorithm gave a secondary role to PVF to assess left ventricular filling pressure. We aimed to test correlations between several PVF parameters, including novel measurements, with LVEDP and to analyze whether PVF parameters have an incremental usefulness over ASE/EACVI algorithm to estimate LVEDP. Seventy-two patients that underwent left and right cardiac catheterization for assessment of heart failure or pulmonary hypertension were enrolled. All patients had a detailed echocardiographic study immediately before catheterization. Patients were categorized into those with an LVEDP < 15 mmHg vs. LVEDP ≥ 15 mmHg to analyze data. Patients with an elevated LVEDP had significantly lower peak S/D velocity ratio, S wave deceleration time, D wave acceleration time and D wave deceleration time (DWDT), as well as higher D wave acceleration rate (DWAR), but only peak S/D velocity ratio (β = − 0.28, p = 0.01), DWDT (β = − 0.33, p = 0.001) and DWAR (β = 0.23, p = 0.03) were independent predictors for an elevated LVEDP. ASE/EACVI algorithm had a sensitivity of 71% and specificity of 74% to predict an elevated LVEDP. When PVF parameters were adjusted for ASE/EACVI algorithm; DWDT and DWAR remained as independent predictors. Sensitivity and specificity of ASE/EACVI algorithm increased to 79% and 96%, respectively, if either DWDT or DWAR was also suggestive of an elevated LVEDP. DWDT and DWAR have incremental usefulness over existing algorithm to determine LVEDP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Borlaug BA, Paulus WJ (2011) Heart failure with preserved ejection fraction: pathophysiology, diagnosis, and treatment. Eur Heart J 32:670–679

    Article  Google Scholar 

  2. Pinamonti B, Di Lenarda A, Sinagra G, Camerini F (1993) Restrictive left ventricular filling pattern in dilated cardiomyopathy assessed by Doppler echocardiography: clinical, echocardiographic and hemodynamic correlations and prognostic implications. Heart Muscle Disease Study Group. J Am Coll Cardiol 22:808

    Article  CAS  Google Scholar 

  3. Galie N, Humbert M, Vachiery J-L, Gibbs S, Lang I, Torbicki A et al (2016) 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J 1(37):67–119

    Article  Google Scholar 

  4. Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA et al (2009) Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr 22:107–133

    Article  Google Scholar 

  5. Nagueh SF, Smiseth OA, Appleton CP, Byrd BF 3rd, Dokainish H, Edvardsen T et al (2016) Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 29:277–314

    Article  Google Scholar 

  6. Smiseth OA, Thompson CR, Lohavanichbutr K, Ling H, Abel JG, Miyagishima RT et al (1999) The pulmonary venous systolic flow pulse–its origin and relationship to left atrial pressure. J Am Coll Cardiol 34:802

    Article  CAS  Google Scholar 

  7. Rossvoll O, Hatle LK (1993) Pulmonary venous flow velocities recorded by transthoracic Doppler ultrasound: relation to left ventricular diastolic pressures. J Am Coll Cardiol 21:1687–1696

    Article  CAS  Google Scholar 

  8. Olariu A, Wellnhofer E, Gräfe M, Fleck E (2003) Non-invasive estimation of left ventricular end-diastolic pressure by pulmonary venous flow deceleration time. Eur J Echocardiogr 4:162–168

    Article  CAS  Google Scholar 

  9. Kuecherer HF, Muhiudeen IA, Kusumoto FM, Lee E, Moulinier LE, Cahalan MK et al (1990) Estimation of mean left atrial pressure from transesophageal pulsed Doppler echocardiography of pulmonary venous flow. Circulation 82:1127

    Article  CAS  Google Scholar 

  10. Bergstra A, van Dijk R, Hillege H, Lie K, Mook G (1995) Assumed oxygen consumption based on calculation from dye dilution cardiac output: an improved formula. Eur Heart J 16:698–703

    Article  CAS  Google Scholar 

  11. Buffle E, Kramarz J, Elazar E, Aviram G, Ingbir M, Nesher N et al (2015) Added value of pulmonary venous flow Doppler assessment in patients with preserved ejection fraction and its contribution to the diastolic grading paradigm. Eur Heart J Cardiovasc Imaging 16:1191–1197

    Article  Google Scholar 

  12. Yamamuro A, Yoshida K, Hozumi T, Akasaka T, Takagi T, Kaji S et al (1999) Noninvasive evaluation of pulmonary capillary wedge pressure in patients with acute myocardial infarction by deceleration time of pulmonary venous flow velocity in diastole. J Am Coll Cardiol 34:90–94

    Article  CAS  Google Scholar 

  13. Chirillo F, Brunazzi MC, Barbiero M, Giavarina D, Pasqualini M, Franceschini-Grisolia E et al (1997) Estimating mean pulmonary wedge pressure in patients with chronic atrial fibrillation from transthoracic Doppler indexes of mitral and pulmonary venous flow velocity. J Am Coll Cardiol 30:19–26

    Article  CAS  Google Scholar 

  14. Kinnaird TD, Thompson CR, Munt BI (2001) The declaration time of pulmonary venous diastolic flow is more accurate than the pulmonary artery occlusion pressure in predicting left atrial pressure. J Am Coll Cardiol 37:2025–2030

    Article  CAS  Google Scholar 

  15. Brunazzi MC, Chirillo F, Pasqualini M, Gemelli M, Franceschini-Grisolia E, Longhini C et al (1994) Estimation of left ventricular diastolic pressures from precordial pulsed-Doppler analysis of pulmonary venous and mitral flow. Am Heart J 128:293–300

    Article  CAS  Google Scholar 

  16. Hunderi JO, Thompson CR, Smiseth OA (2006) Deceleration time of systolic pulmonary venous flow: a new clinical marker of left atrial pressure and compliance. J Appl Physiol 100:685–689

    Article  CAS  Google Scholar 

  17. Andersen OS, Smiseth OA, Dokainish H, Abudiab MM, Schutt RC, Kumar A et al (2017) Estimating left ventricular filling pressure by echocardiography. J Am Coll Cardiol 69:1937–1948

    Article  Google Scholar 

  18. Abergel E, Lafitte S, Mansencal N (2018) Evaluation of left ventricular filling pressure: updated recommendations lack new evidence and have severe interpretation issues. Arch Cardiovasc Dis 111:707–711

    Article  Google Scholar 

  19. Halpern SD, Taichman DB (2009) Misclassification of pulmonary hypertension due to reliance on pulmonary capillary wedge pressure rather than left ventricular end-diastolic pressure. Chest 136:37–43

    Article  Google Scholar 

  20. Lancellotti P, Galderisi M, Edvardsen T et al (2017) Echo-Dopplerestimation of left ventricular filling pressure: results of themulticentre EACVI Euro-Filling study. Eur Heart J Cardiovasc Imaging 18:961–968

    Article  Google Scholar 

  21. Sohn DW, Choi YJ, Oh BH, Lee MM, Lee YW (1999) Estimation of left ventricular end-diastolic pressure with the difference in pulmonary venous and mitral A durations is limited when mitral E and A waves are overlapped. J Am Soc Echocardiogr 12:106–112

    Article  CAS  Google Scholar 

  22. Jensen JL, Williams FE, Beilby BJ, Johnson BL, Miller LK, Ginter TL et al (1997) Feasibility of obtaining pulmonary venous flow velocity in cardiac patients using transthoracic pulsed wave Doppler technique. J Am Soc Echocardiogr 10:60–66

    Article  CAS  Google Scholar 

Download references

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Cardiology, VM Medical Park Pendik Hospital, Eski Karakol Str. No: 9 Pendik, Istanbul, Turkey

    Tolga Sinan Güvenç

  2. Department of Cardiology, Dr. Siyami Ersek Cardiovascular and Thoracic Surgery Research and Training Hospital, Istanbul, Turkey

    Esra Poyraz & Fatma Can

  3. Department of Cardiology, Haydarpasa Numune Hospital, Istanbul, Turkey

    Rengin Çetin Güvenç

Authors
  1. Tolga Sinan Güvenç
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Esra Poyraz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rengin Çetin Güvenç
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fatma Can
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tolga Sinan Güvenç.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests for this study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Güvenç, T.S., Poyraz, E., Çetin Güvenç, R. et al. Contemporary usefulness of pulmonary venous flow parameters to estimate left ventricular end-diastolic pressure on transthoracic echocardiography. Int J Cardiovasc Imaging 36, 1699–1709 (2020). https://doi.org/10.1007/s10554-020-01886-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-020-01886-6

Keywords

Search

Navigation