Assessment of left ventricular end-diastolic pressure by Doppler echocardiography: Contribution of duration of pulmonary venous versus mitral flow velocity curves at atrial contraction

The difference in the durations of flow with atrial contraction (A duration) at the pulmonary veins and mitral valve has been reported to detect the presence of elevated left ventricular end-diastolic pressure. It is postulated that with left ventricular filling during atrial contraction, reduced ventricular compliance results in the transmission of increased pressure into the left atrium, resulting in prolongation of the pulmonary venous flow with atrial contraction. However, the relationship between ventricular compliance during atrial contraction and the pulmonary venous and mitral A durations and their difference have not been carefully examined. We performed recordings of left ventricular pressure and complete Doppler analysis of pulmonary venous and transmitral flow in 87 patients. Operant ventricular compliance at atrial contraction was estimated by measuring the increase in ventricular pressure with atrial contraction (left ventricular a wave) and by using a compliance index, which incorporated an estimate of flow into the ventricle with atrial contraction from the Doppler transmitral a wave. The difference in pulmonary venous and mitral A durations correlated well with left ventricular end-diastolic pressure (r = 0.73, p < 0.01) and the pulmonary venous reversal duration exceeding the duration of the mitral A velocity curve provided high sensitivity (82%) and specificity (92%) for the detection of an end-diastolic pressure of 20 mm Hg or greater. The pulmonary venous A duration increased with a moderate decrease in ventricular compliance but was not increased further in patients with a severe decrease in compliance. In contrast, mitral A duration was not different in patients with moderate reduction in compliance, but was shorter in patients with severe decreases in ventricular compliance. Pulmonary venous and mitral A durations are related to ventricular compliance and they change in an opposite and progressive manner. Their difference is a sensitive method for the detection of the elevated end-diastolic pressure associated with reduction in ventricular compliance.