Abstract
Background: Pulmonary capillary wedge pressure (PCWP) is a useful index of preload and an important determinant of cardiac function.
Hypothesis: We postulated that the rate of blood propagating into the left atrium (LAIF‐PR) would be a useful measure of PCWP in critically ill patients.
Methods: Fifty‐two critically ill patients (36 men/16 women) receiving mechanical ventilation were studied by multiplane transesophageal echocardiography (TEE). Left atrial inflow propagation rate was measured in systole and diastole as the slope of the color M‐mode signal entering the left atrium from the right upper pulmonic vein.
Results: Systolic and diastolic LAIF‐PRs were feasible in 49 and 44 patients, respectively. Mean (± 1 standard deviation) LAIF‐PR in systole was 40 ± 26 cm/s (range 11‐132) and in diastole 34 ± 22 cm/s (range 5‐102). Negative correlations with PCWP (mean 19 ± 9 mmHg; range 3‐40) were good for LAIF‐PR in systole (r = −0.71, standard error of estimate [SEE] = 6 mmHg; p< 0.0001) and diastole (r = −0.71, SEE = 6 mmHg; p < 0.0001). Mean ejection fraction was 52 ± 22% (range 15‐88) and cardiac output was 6.97 ±3.52 l/min (range 2.26‐17.93). Multivariate regression showed PCWP as the only independent predictor of systolic (p < 0.0001) and diastolic (p < 0.0001) LAIF‐PR among age, heart rate, cardiac output, ejection fraction, or left atrial diameter.
Conclusions: Left atrial inflow propagation rate derived by color M‐mode TEE aligned with the right upper pulmonic vein is a promising new index of preload. Future studies addressing the determinants of LAIF‐PR, such as left atrial compliance, are needed.
Keywords: echocardiography, transesophageal echocardiography, preload, pulmonary capillary wedge pressure
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