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• W2022285273 abstract "The accuracy with which pulmonary pressures reflect sudden changes in left ventricular (LV) pressures was studied in 15 patients without mitral disease. Mean pulmonary artery (PA), pulmonary artery end-diastolic (PAd), mean pulmonary capillary (PC), and pulmonary capillary V wave (PCa) pressures were compared with simultaneous LV diastolic pressures measured before (LV pre V) and after atrial systole (LVEDP). Recordings were made at rest and after angiography. There were significant correlations (r > 0.75, P < 0.01) between LV diastolic pressures and each of the pulmonary pressures. The LVEDP and PCa related most closely (r = 0.98). Differences of 5 mm Hg or more between LVEDP and either PAd or PC occurred in more than 50 percent of the observations and were due to large LV “a” waves. The PC, and to a lesser degree the PAd, were more closely related to LV pre “a” than to LVEDP. Changes (Δ) in PCa after LV angiography approximated ΔLVEDP, while ΔPAD and ΔPC reflected ΔLV pre “a” more closely than ΔLVEDP. In conclusion, PCa reflects the LV “a” wave and, thus, is the most accurate index for LVEDP and ΔLVEDP in patients with LV dysfunction. The PC reflects LV pre “a” (mean LV filling pressure) but is an unreliable index of LVEDP. The PC is more easily measured than PCa and, with proper interpretation, should remain the most useful measurement for patient monitoring. The accuracy with which pulmonary pressures reflect sudden changes in left ventricular (LV) pressures was studied in 15 patients without mitral disease. Mean pulmonary artery (PA), pulmonary artery end-diastolic (PAd), mean pulmonary capillary (PC), and pulmonary capillary V wave (PCa) pressures were compared with simultaneous LV diastolic pressures measured before (LV pre V) and after atrial systole (LVEDP). Recordings were made at rest and after angiography. There were significant correlations (r > 0.75, P < 0.01) between LV diastolic pressures and each of the pulmonary pressures. The LVEDP and PCa related most closely (r = 0.98). Differences of 5 mm Hg or more between LVEDP and either PAd or PC occurred in more than 50 percent of the observations and were due to large LV “a” waves. The PC, and to a lesser degree the PAd, were more closely related to LV pre “a” than to LVEDP. Changes (Δ) in PCa after LV angiography approximated ΔLVEDP, while ΔPAD and ΔPC reflected ΔLV pre “a” more closely than ΔLVEDP. In conclusion, PCa reflects the LV “a” wave and, thus, is the most accurate index for LVEDP and ΔLVEDP in patients with LV dysfunction. The PC reflects LV pre “a” (mean LV filling pressure) but is an unreliable index of LVEDP. The PC is more easily measured than PCa and, with proper interpretation, should remain the most useful measurement for patient monitoring. Limitations of ElectrocardiogramsCHESTVol. 68Issue 4PreviewWhile it should be quite obvious that the electrocardiogram per se does not always provide a clear indication of the etiology of abnormalities of rhythm or conduction, almost since its inception, the field of electrocardiography has been rife with such examples, to wit: upper, middle, and lower atrioventricular nodal rhythms; coronary sinus rhythms; left atrial rhythms; right atrial rhythms; and various forms of bundle-branch block. The articles in this issue of Chest by Suarez de Lezo et al (see page 548 ) and LaCorte et al (see page 575 ) provide a valuable service by demonstrating once again the limitations of the ECG in understanding the mechanisms and genesis of various abnormalities in cardiac rhythm and conduction. Full-Text PDF" @default.
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• W2022285273 title "Assessing Left Ventricular Filling Pressure with Flow-Directed (Swan-Ganz) Catheters" @default.
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• W2022285273 doi "https://doi.org/10.1378/chest.68.4.542" @default.
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