Noninvasive Echocardiographic Estimation of Pulmonary Wedge Pressure in Candidates for and Recipients of Heart Transplantation

Objective We assessed the value of deceleration time (dt) of diastolic wave of pulmonary venous flow (PVF) (PVF_dt) as noninvasive estimation of pulmonary wedge pressure (PWP) in candidates for and recipients of heart transplantation. Methods We prospectively recruited 51 patients with end-stage congestive heart failure (group A) and 49 recipients of heart transplantation (group B). PWP and PVF_dt were measured using a Swan-Ganz catheter and Doppler echocardiography, respectively. We performed regression analyses to assess interrelationships. Moreover, we used the area under the receiver operating characteristic curve to assess how clearly PVF_dt could discriminate between normal and elevated PWP values. Results In both study groups, PWP was inversely associated with PVF_dt ( R2 = 0.785 and 0.797, respectively, P < .001). A cut-off value of less than 187 milliseconds was predictive of an elevated PWP value (≥12 mm Hg) in both study groups. Specificity and sensitivity were between 90% and 100%, respectively, in both study groups. The area under the receiver operating characteristic curve was 0.961 (0.908-1.013; P < .001) for group A and 0.998 (0.992-1.04; P < .001) for group B. Conclusion In recipients of heart transplantation and patients with end-stage congestive heart failure, the noninvasive measuring of PVF_dt distinguishes between normal and elevated PWP values.