A close relation between the Doppler-echocardiographic transmitral flow signal (TMF) and the left ventricular filling pressure in patients with coronary heart disease (CHD) was described in several reports. The present study investigated the validity of this relation during an episode of acute ischemia induced by coronary angioplasty (PTCA) by simultaneous recording of TMF and mean pulmonary capillary wedge pressure (PCm). Thirty-nine patients were examined at rest, and 33 of them were further studied during a subsequent PTCA of the left anterior descending artery (n = 22) or the right coronary artery (n = 11). The onset of ischemia was evaluated by electrocardiography. The Doppler-echocardiographic parameters of diastolic ventricular function were correlated with PCm; the closest correlation was obtained for the relation between PCm and the ratio of the early/atrial velocity integral (Ei/Ai: r = 0.59; p less than 0.0001), and between PCm and the relative share of the early diastolic velocity integral (Ei%: r = 0.58; p less than 0.0001). A wide confidence interval of individual values did not allow a calculation of PCm from Ei/Ai. By a semiquantitative approach an elevated PCm could be estimated from Ei/Ai greater than 1.5 with a high sensitivity (86%) and specificity (81%). During PTCA an increase of PCm was observed (start: 10.2 +/- 4.8; end: 15.0 +/- 6.5; p less than 0.0001), while Ei/Ai decreased slightly (start: 1.37 +/- 0.41; end: 1.27 +/- 0.51; p = 0.32). With increasing duration of inflation, the correlation between PCm and Doppler-echocardiographic parameters was attenuated.(ABSTRACT TRUNCATED AT 250 WORDS)