• Alain Combes, Florence Arnoult, and Jean-Louis Trouillet.
• Réanimation Médicale,Institut de Cardiologie, AP-HP, Hôpital Pitié-Salpêtrière, 47 Boulevard de l'Hôpital, 75013 Paris, France. alain.combes@psl.ap-hop-paris.fr
• Intensive Care Med. 2004 Jan 1;30(1):75-81.

ObjectiveEarlier reports suggested that transthoracic (TTE) determination of the ratio of mitral inflow E wave velocity to early diastolic mitral annulus velocity (E/E') measured by tissue Doppler imaging (TDI) closely approximates PAOP in cardiac patients. However, the value of E/E' for PAOP assessment in ICU patients has not been evaluated. This study assessed whether the E/E' ratio provides an accurate estimation of pulmonary artery occlusion pressure (PAOP) in mechanically ventilated ICU patients.Design And SettingProspective, open, clinical study in the ICU of a university hospital.PatientsTwenty-three consecutive mechanically ventilated patients.InterventionsVolume expansion in 14 patients.Measurements And ResultsDoppler TTE or TEE mitral inflow and TDI mitral annulus velocities were determined and compared with PAOP measured using a Swan-Ganz catheter. Of all the Doppler variables studied the best correlations were observed between PAOP and the lateral (r=0.84) and medial (r=0.76) annulus E/E' ratio and remained highly significant when the analysis was restricted to TEE (r=0.91 and 0.86) or TTE (r=0.73 and 0.61). The sensitivities and specificities of estimating PAOP at 15 mmHg or higher were, respectively, 86% and 81% for lateral E/E' above 7.5 and 76% and 80% for medial E/E' above 9. PAOP changes after volume expansion (700+/-230 ml) were limited and accurately assessed by repeated E/E' determinations.ConclusionsIn mechanically ventilated ICU patients TTE or TEE E/E' determinations using TDI closely approximate PAOP.

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