Garcia M J, Ares M A, Asher C, Rodriguez L, Vandervoort P, Thomas J D
Veterans Affairs Medical Center, White River Junction, Vermont, USA.
J Am Coll Cardiol. 1997 Feb;29(2):448-54. doi: 10.1016/s0735-1097(96)00496-2.
This study sought to determine the applicability of the combined information obtained from transmitral Doppler flow and color M-mode Doppler flow propagation velocities for estimating pulmonary capillary wedge pressure.
Although Doppler-derived measurements of left ventricular (LV) filling have been applied to determine left atrial pressure, their accuracy has been limited by the variable effect of ventricular relaxation in these indexes. Recently, flow propagation velocity measured by color M-mode Doppler echocardiography has been suggested as an index of ventricular relaxation.
We studied 45 patients admitted to the intensive care unit who underwent invasive hemodynamic monitoring. We measured peak early (E) and late (A) transmitral Doppler velocities, E/A ratio and flow propagation velocity (vp) and compared them by linear regression with pulmonary capillary wedge pressure (pw).
We found a modest positive correlation between pw and E (r = 0.62, p < 0.001) and the E/A ratio (r = 0.52, p < 0.001) and a negative correlation between pw and vp (r = -0.34, p = 0.02). By stepwise linear regression, only E and vp were statistically significant predictors of pw. However, the E/vp ratio provided the best estimate of pw (r = 0.80, p < 0.001; pw = 5.27 x [E/vp] + 4.6, SEE 3.1 mm Hg).
The ratio of component velocity (E) over the color M-mode propagation velocity during early LV filling, by correcting for the effect of LV relaxation, provides a better estimate of pw than standard measurements of transmitral Doppler flow.
本研究旨在确定经二尖瓣多普勒血流和彩色M型多普勒血流传播速度所获得的综合信息在估计肺毛细血管楔压方面的适用性。
尽管基于多普勒的左心室（LV）充盈测量已用于确定左心房压力，但其准确性受到这些指标中心室舒张可变效应的限制。最近，彩色M型多普勒超声心动图测量的血流传播速度已被提议作为心室舒张的一个指标。
我们研究了45名入住重症监护病房且接受有创血流动力学监测的患者。我们测量了早期（E）和晚期（A）经二尖瓣多普勒速度、E/A比值以及血流传播速度（vp），并通过线性回归将它们与肺毛细血管楔压（pw）进行比较。
我们发现pw与E（r = 0.62，p < 0.001）和E/A比值（r = 0.52，p < 0.001）之间存在适度正相关，而pw与vp之间存在负相关（r = -0.34，p = 0.02）。通过逐步线性回归，只有E和vp是pw的统计学显著预测因子。然而，E/vp比值对pw的估计最佳（r = 0.80，p < 0.001；pw = 5.27×[E/vp] + 4.6，标准误3.1 mmHg）。
通过校正左心室舒张的影响，左心室早期充盈时成分速度（E）与彩色M型传播速度的比值比经二尖瓣多普勒血流的标准测量能更好地估计pw。
