Background: Noninvasive estimation of pulmonary capillary wedge pressure (PCWP) with Doppler-derived mitral inflow pattern has been shown to correlate well with invasively measured PCWP; however, it has not yet been determined whether Doppler-derived mitral inflow pattern can be used to estimate PCWP accurately in heart transplant recipients. Methods: To determine if mitral and pulmonary venous inflow data can be applied to calculate PCWP in heart transplant recipients, same-day echocardiograms and right heart catheterizations were reviewed and 83 echocardiograms with adequate mitral inflow patterns in 53 patients were studied. Twenty-eight studies that also had adequate pulmonary venous inflow patterns were selected for offline analysis. Results: Using a previously published formula [PCWP = 17 + (5.3 × E/A) – (0.11 × IVRT)], where E/A is the ratio of early to late mitral inflow velocities and IVRT is the isovolumic relaxation time, we derived a calculated PCWP, the results of which compared poorly with the measured PCWP (r = 0.33; p = 0.002). Linear regression analysis of measured PCWP versus mitral inflow Doppler flow velocity parameters also revealed poor to modest correlation. Adding parameters derived from the pulmonary venous inflow patterns failed to improve this correlation. Conclusion: Doppler-derived estimation of PCWP with mitral and pulmonary venous inflow patterns cannot be used to reliably predict PCWP in heart transplant recipients. (Am Heart J 1998;135:641-6.)