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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: July 2005 - Volume 6 - Issue 4 - p 448-453
doi: 10.1097/01.PCC.0000164345.86775.35
Cardiac Intensive Care

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.

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