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Tissue Doppler echocardiographic and color M-mode estimation of left atrial pressure in infants*

Larrazet, Fabrice MD; Bouabdallah, Kamel MD; Le Bret, Emmanuel MD; Vouhé, Pascal MD; Veyrat, Colette MD; Laborde, François MD

Pediatric Critical Care Medicine:
doi: 10.1097/01.PCC.0000164345.86775.35
Cardiac Intensive Care
Abstract

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.

Author Information

From the Department of Cardiology, Institut Mutualiste Montsouris, Paris, France.

©2005The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies