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"Peak Summation" Left Ventricular Filling Pattern in Patients with Chronic Heart Failure: Frequency and Complementary Value of Pulmonary Venous Flow in Its Hemodynamic Interpretation.
MedLine Citation:
PMID:  11175104     Owner:  NLM     Status:  Publisher    
In patients with chronic heart failure (CHF) and a "peak summation" left ventricular pattern, no hemodynamic and prognostic information can be drawn from Doppler examination of mitral flow. In 263 consecutive patients with CHF who were undergoing simultaneous right heart catheterization and echo-Doppler examination, we prospectively determined (1) the frequency of the peak summation left ventricular filling pattern and (2) the incremental information contributed by pulmonary venous flow velocity patterns in providing noninvasive hemodynamic profile estimation. Isovolumic relaxation time of mitral flow, peak systolic (X), diastolic forward (Y), reverse (Z) flow velocity, and systolic fraction (X/X + Y) of pulmonary venous flow were measured. Forty-six of 263 (17%) patients had a peak summation left ventricular filling pattern. This subgroup showed more clinical deterioration (New York Heart Association functional class III-IV, 57% vs 49%; P < 0.01) and left atrial dysfunction (left atrial ejection fraction, 31% vs 39%; P < 0.001). However, 40% of these patients had a pulmonary wedge pressure of <18 mmHg and a cardiac index of >2.2 L/min/m(2). The systolic fraction of peak velocities of pulmonary venous flow showed a good correlation with pulmonary wedge pressure (r = -0.70, P < 0.05). The correlation was stronger in patients without mitral regurgitation (r = -0.81, P < 0.05). A systolic fraction of <40% was accurate (sensitivity, 100%; specificity, 95%) in identifying patients with a pulmonary wedge pressure of >18 mmHg. In patients without mitral regurgitation, this variable was also correlated with cardiac index (r = -0.65, P < 0.05) and predicted a cardiac index of >2.2 L/min/m(2) (sensitivity, 91%; specificity, 71%). In conclusion, a peak summation left ventricular filling pattern is common in patients with CHF. Pulmonary venous flow provides useful information about the hemodynamic profile of these patients.
Soccorso Capomolla; Oreste Febo; Giorgio Riccardi; Paolo Parziale; Giandomenico Pinna; Cristina Opasich; Franco Cobelli; Luigi Tavazzi
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Publication Detail:
Journal Detail:
Title:  Echocardiography (Mount Kisco, N.Y.)     Volume:  15     ISSN:  1540-8175     ISO Abbreviation:  Echocardiography     Publication Date:  1998 Nov 
Date Detail:
Created Date:  2001-Feb-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8511187     Medline TA:  Echocardiography     Country:  -    
Other Details:
Languages:  ENG     Pagination:  721-730     Citation Subset:  -    
Department of Cardiology, Montescano Medical Center, Via per Montescano, 27040 Montescano, Pavia, Italy.
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