Shortened Doppler-derived mitral A wave deceleration time: An important predictor of elevated left ventricular filling pressure

Objectives. The aim of this study was to investigate whether a new variable of mitral inflow, A wave deceleration time, identifies patients with elevated left ventricular filling pressures. Background. In patients with an elevated left ventricular end-diastolic pressure, the increase in left ventricular pressure after atrial contraction rapidly exceeds left atrial pressure, resulting in abrupt cessation of the A wave. Therefore, we postulated that a shortening of A wave deceleration time might be a marker for elevated end-diastolic pressure. Methods. Adequate pulsed Doppler mitral inflow velocities could be recorded in 40 of 44 consecutive patients undergoing cardiac catheterization simultaneously with capillary wedge pressure in 20 patients, and within 1 h after left ventricular end-diastolic pressure recording in 20. Fifteen healthy volunteers were also studied. Results. Left ventricular end-diastolic pressure was 8 to 35 mm Hg, and mean pulmonary wedge pressure was 6 to 37 mm Hg. Close correlations were found between A wave deceleration time and mean pulmonary wedge pressure (r = -0.87) and left ventricular end-diastolic pressure (r = -0.74). There were modest correlations between both pressures and peak E/A, E wave deceleration time and A wave duration, respectively: r = 0.59, -0.30 and -0.58 for capillary wedge and r = 0.25, -0.38 and -0.49 for end-diastolic pressures. A wave deceleration time ≤ 60 ms predicted left ventricular end-diastolic and mean pulmonary wedge pressures > 18 mm Hg, respectively, with a sensitivity of 67% and 89% and specificity of 100% for both. Conclusions. A shortened Doppler mitral inflow A wave deceleration time is a useful index of elevated left ventricular filling pressure.