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

J Am Coll Cardiol. 1996 Mar 1;27(3):700-5. doi: 10.1016/0735-1097(95)00505-6.


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 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.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Cardiac Catheterization
  • Case-Control Studies
  • Confounding Factors, Epidemiologic
  • Deceleration
  • Echocardiography, Doppler
  • Female
  • Heart Diseases / diagnostic imaging*
  • Heart Diseases / physiopathology*
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Pulmonary Wedge Pressure
  • Sensitivity and Specificity
  • Stroke Volume*
  • Ventricular Pressure*