The noninvasive assessment of pulmonary capillary wedge pressure in mitral regurgitation.

The interval between the aortic closure sound and the mitral opening snap (A2-OS) has been shown to have a significant inverse correlation with pulmonary capillary wedge pressure (PCW) in mitral stenosis. The present study critically examines the relationship of several noninvasively determined diastolic intervals to PCW in patients with relatively pure mitral regurgitation (MR). Fifty-seven patients with MR of diverse etiologies were studied with echocardiograms and phonocardiograms in addition to right and left heart catheterization. Noninvasive determination of the time intervals of aortic closure sound to mitral valve opening (A2-MO), mitral D point to E point (D-E), aortic closure sound to mitral E point (A2-E), the interval from the onset of the QRS to mitral closure (Q-C), and the ratio Q-C/A2-E were compared to invasive measurements of mean PCW, the height of the V wave of PCW (PCW-V), and the ratio of PCW-V to left ventricular (LV) peak systolic pressure (PCW-V/LV). Correlation between each of the five noninvasive intervals and each of the three invasive pressure measurements was then determined. Of the noninvasive intervals studied, A2-MO had the best inverse correlation with all measures of PCW. All 18 patients having a short A2-MO (less than 40 msec) had a PCW-V of greater than or equal to 40 mm Hg and all seven patients having a long A2-MO (greater than 85 msec) had a PCW-V of less than 22 mm Hg. A2-E also had a strong inverse correlation with PCW.(ABSTRACT TRUNCATED AT 250 WORDS)