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Deceleration time of systolic pulmonary venous flow: a new clinical marker of left atrial pressure and compliance

¹Institute for Surgical Research and Department of Cardiology, Rikshospitalet University Hospital, Oslo, Norway; and ²St. Paul’s Hospital and University of British Columbia, Vancouver, British Columbia, Canada

Submitted 15 June 2005 ; accepted in final form 13 October 2005

The curvilinearity of the atrial pressure-volume curve implies that atrial compliance decreases progressively with increasing left atrial (LA) pressure (LAP). We predicted that reduced LA compliance leads to more rapid deceleration of systolic pulmonary venous (PV) flow. With this rationale, we investigated whether the deceleration time (t_dec) of PV systolic flow velocity reflects mean LAP. In eight patients during coronary surgery, before extracorporeal circulation, PV flow by ultrasonic transit time and invasive LAP were recorded during stepwise volume loading. The t_dec was calculated using two methods: by drawing a tangent through peak deceleration and by drawing a line from peak systolic flow through the nadir between the systolic and early diastolic flow waves. LA compliance was calculated as the systolic PV flow integral divided by LAP increment. Volume loading increased mean LAP from 11 ± 3 to 20 ± 5 mmHg (P < 0.001) (n = 40), reduced LA compliance from 1.16 ± 0.42 to 0.72 ± 0.40 ml/mmHg (P < 0.004) (n = 40), and reduced t_dec from 320 ± 50 to 170 ± 40 ms (P < 0.0005) (n = 40). Mean LAP correlated well with t_dec (r = 0.84, P < 0.0005) (n = 40) and LA compliance (r = 0.79, P < 0.0005) (n = 40). Elevated LAP caused a decrease in LA compliance and therefore more rapid deceleration of systolic PV flow. The t_dec has potential to become a semiquantitative marker of LAP and an index of LA passive elastic properties.

left atrial compliance; left ventricular end-diastolic pressure; pulmonary venous flow