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Accuracy of left atrial and pulmonary artery wedge pressure in pure mitral regurgitation in predicting left ventricular end-diastolic pressure

  • Richard J. Haskell
    Affiliations
    From the Department of Medicine, University of California, Los Angeles School of Medicine, Los Angeles, USA

    From the Department of Medicine, Division of Cardiology, Harbor-UCLA Medical Center, Torrance, California, USA
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  • William J. French
    Correspondence
    Address for reprints: William J. French, MD, Division of Cardiology, Harbor-UCLA Medical Center, 1000 West Carson Street, Torrance, California 90509.
    Affiliations
    From the Department of Medicine, University of California, Los Angeles School of Medicine, Los Angeles, USA

    From the Department of Medicine, Division of Cardiology, Harbor-UCLA Medical Center, Torrance, California, USA
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      Abstract

      In most clinical conditions pulmonary artery (PA) wedge pressure accurately reflects left ventricular (LV) end-diastolic pressure. In the presence of mitral regurgitation (MR), large V waves can distort PA wedge pressure and result in incorrect estimation of LV end-diastolic pressure. In 52 patients with MR simultaneous measurement of PA wedge pressure or left atrial pressure and LV end-diastollc pressure was recorded. Twenty-one (40%) patients had large V waves (V wave > A wave by > 10 mm Hg, group 1), and 31 (60%) patients had small V waves (group 2). Group 1 had significantly higher V waves than group 2 (46 ± 3 vs 21 ± 2 mm Hg, p < 0.001). The LV end-diastolic pressure was similar in both groups (21 ± 2 vs 19 ± 2 mm Hg, difference not significant). The mean PA wedge or left atrial pressure in group 1 (26 ± 2 mm Hg) overestimated LV end-diastolic pressure (21 ± 2 mm Hg) by 30% (p < 0.01), but the trough of the X descent (20 ± 2 mm Hg) was similar to the LV end-diastolic pressure. In group 2 patients with small V waves the mean PA wedge pressure was not significantly different from the LV end-diastolic pressure (16 ± 2 vs 19 ± 2 mm Hg, p = 0.06), but the trough of the X descent (13 ± 2 mm Hg) underestimated LV end-diastolic pressure. Thus, in patients with large left atrial V waves due to MR, the trough of the X descent is the best predictor of LV end-diastolic pressure. In contrast, if the V wave is small, the mean PA wedge or left atrial pressure can still estimate LV end-diastolic pressure despite the presence of MR.
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