Objectives: Using recorded flow and tissue Doppler, we evaluated the relation of peak velocity of early transmitral Doppler filling (E)/early diastolic velocity of the lateral mitral annulus (Ea) ratio and of E/flow propagation velocity (Vp) ratio to mean left atrial pressure in infants after surgery for congenital heart disease.
Design: Experimental design.
Setting: Pediatric intensive care unit.
Patients: Thirty-seven infants aged 4 (3–8) months.
Interventions: Patients underwent postoperative invasive hemodynamic monitoring with simultaneously obtained Doppler measurements.
Measurements and Main Results: Values are expressed as median (25th–75th percentiles). Heart rate was 145 (135–157) beats/min. Left atrial pressure was 10 (8–12) mm Hg with E/Ea 16 (12–19) and E/Vp 1.9 (1.3–2.4). E/Ea and E/Vp ratios were higher in patients with left atrial pressure >10 mm Hg (n = 18), than in patients with left atrial pressure ≤10 mm Hg (n = 19) (E/Ea, 16 [15–25] vs. 12 [9–17], p = .01; E/Vp, 2.3 [1.9–2.8] vs. 1.4 [1–1.9]. respectively, p = .001). At a cutoff point of 15, E/Ea sensitivity for left atrial pressure >10 mm Hg was 17 of 18 (94%) with specificity 13 of 18 (72%). At a cutoff point of 2, E/Vp sensitivity for left atrial pressure >10 mm Hg was 15 of 18 (83%) with specificity 16 of 18 (89%). Areas under the receiver operating characteristic curves were 0.76 (E/Ea) and 0.83 (E/Vp).
Conclusions: Doppler ratios might be considered as promising noninvasive tools for left atrial pressure evaluation in infants after cardiac surgery.
From the Department of Cardiology, Institut Mutualiste Montsouris, Paris, France.