Original article
Abnormal Septal Motion Affects Early Diastolic Velocities at the Septal And Lateral Mitral Annulus, and Impacts on Estimation of the Pulmonary Capillary Wedge Pressure

https://doi.org/10.1016/j.echo.2005.01.005Get rights and content

Abnormal motion of the interventricular septum (ASM), seen post cardiac operation, with left bundle branch block or right ventricular pacing, may affect septal mitral annular motion and correlation of the ratio between the velocity of early diastolic mitral inflow and the early diastolic mitral annular velocity (E/Ea) with pulmonary capillary wedge pressure (PCWP). We examined the effect of ASM on the relationship between E/Ea and E/Vp (propagation velocity of mitral inflow) ratios and PCWP in adult patients in the intensive care unit (14 with normal septal motion [NSM], 36 with ASM) undergoing echocardiography and pulmonary artery catheterization. E/Ea correlated well with PCWP during NSM (r = 0.86 lateral annulus, r = 0.75 septal annulus), but poorly during ASM (r = 0.36 lateral annulus, r = 0.39 septal annulus). E/Vp correlated poorly with PCWP (r = 0.05 NSM, r = 0.17 ASM). For patients who are critically ill, E/Vp ratios poorly estimate PCWP. During NSM, E/Ea ratios measured at the lateral or septal annulus correlate well with PCWP. ASM affects E/Ea ratios at both the septal and lateral annulus, making E/Ea ratios unreliable for estimating PCWP in this group.

Section snippets

Patient demographics

In all, 50 patients admitted to the intensive care unit at either study institution were prospectively included in this study. The human research ethics committees at both hospitals approved this study, and written informed consent was obtained from each patient or their next of kin. Patients were included if a pulmonary artery catheter was inserted as part of their routine medical care. Exclusion criteria included the presence of atrial fibrillation; mitral valve stenosis, mitral valve

Population characteristics

Of the initial population of 50 patients, 14 patients had NSM and 36 patients had ASM. Patients with NSM were in the intensive care unit because of complex medical (sepsis in two patients, pneumonia in four, multiorgan failure in one, decompensated liver disease in one, pancreatitis in one, acute pulmonary edema in one, cardiogenic shock in one) or surgical (post liver transplant in one patient, and ruptured abdominal aortic aneurysm in two) problems.

All patients with ASM on echocardiography

Discussion

This study demonstrates that in the noninvasive assessment of PCWP for patients who are critically ill, ASM renders the E/Ea ratio unreliable when measured at either the septal or the lateral mitral annulus. In the patient group with NSM, the E/Ea ratio measured at the septal and lateral mitral annulus correlated well with invasively measured PCWP and may be useful in the noninvasive estimation of PCWP in the future in patients who are critically ill. In this study, the Doppler-derived PCWP

References (30)

Cited by (0)

This work was supported in part by a Project Grant from the National Heart Foundation of Australia (G01M0312). Dr D’Souza is the recipient of a Medical Postgraduate Research Fellowship from the National Health and Medical Research Council of Australia.

View full text