Usefulness of the Continuous-Wave Doppler-Derived Pulmonary Arterial–Right Ventricular Pressure Gradient Just before Atrial Contraction for the Estimation of Pulmonary Arterial Diastolic and Wedge Pressures

In our new echocardiographic method, pulmonary regurgitant velocity immediately before right atrial (RA) contraction is used to estimate pulmonary artery diastolic pressure (PADP) and mean PA wedge pressure (MPAWP). Our aim here was to compare the usefulness of this new method with that of the conventional method, which uses pulmonary regurgitant velocity at end diastole. We studied 55 consecutive patients who underwent echocardiography and right-sided heart catheterization. The pulmonary regurgitant velocities just before RA contraction and at end diastole were measured to obtain echocardiographic estimates of PADP (EPADP_preA and EPADP_ED, respectively) by adding the pressure gradients to the echocardiographically estimated RA pressure. Compared with EPADP_ED, EPADP_preA correlated better with PADP (r = 0.87) and MPAWP (r = 0.80), and direct fixed biases were detected for EPADP_ED but not for EPADP_preA. The area under the receiver operating characteristic curve distinguishing patients with MPAWP ≥18 mm Hg was greater for EPADP_preA (0.97) than for E/e′ (0.94) and E/A (0.83). EPADP_preA is thus useful in estimating PADP and MPAWP in patients with heart disease.