title: Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures.
abstract: OBJECTIVE
  This investigation was designed 1) to assess whether the early diastolic velocity of the mitral annulus (Ea) obtained with Doppler tissue imaging (DTI) behaves as a preload-independent index of left ventricular (LV) relaxation; and 2) to evaluate the relation of the mitral E/Ea ratio to LV filling pressures.
  
  
  BACKGROUND
  Recent observations suggest that Ea is an index of LV relaxation that is less influenced by LV filling pressures.
  
  
  METHODS
  One hundred twenty-five study subjects were classified into three groups according to mitral E/A ratio, LV ejection fraction (LVEF) and clinical symptoms: 34 asymptomatic subjects with a normal LVEF and an E/A ratio > or =1; 40 with a normal LVEF, an E/A ratio <1 and no heart failure symptoms (impaired relaxation [IR]); and 51 with heart failure symptoms and an E/A ratio >1 (pseudonormal [PN]). Ea was derived from the lateral border of the annulus. A subset of 60 patients had invasive measurement of pulmonary capillary wedge pressure (PCWP) simultaneous with Doppler echocardiographic DTI.
  
  
  RESULTS
  Ea was reduced in the IR and PN groups compared with the group of normal subjects: 5.8 +/- 1.5 and 5.2 +/- 1.4 vs. 12 +/- 2.8 cm/s, respectively (p < 0.001). Mean PCWP (20 +/- 8 mm Hg) related weakly to mitral E (r = 0.68) but not to Ea. The E/Ea ratio related well to PCWP (r = 0.87; PCWP = 1.24 [E/Ea] + 1.9), with a difference between Doppler and catheter measurements of 0.1 +/- 3.8 mm Hg.
  
  
  CONCLUSIONS
  Ea behaves as a preload-independent index of LV relaxation. Mitral E velocity, corrected for the influence of relaxation (i.e., the E/Ea ratio), relates well to mean PCWP and may be used to estimate LV filling pressures.
authors.affiliation: Baylor College of Medicine and Department of Medicine, The Methodist Hospital, Houston, Texas 77030, USA. sherifn@bcm.tmc.edu
authors.forename: S F
authors.initials: SF
authors.lastname: Nagueh
authors.forename: K J
authors.initials: KJ
authors.lastname: Middleton
authors.forename: H A
authors.initials: HA
authors.lastname: Kopelen
authors.forename: W A
authors.initials: WA
authors.lastname: Zoghbi
authors.forename: M A
authors.initials: MA
authors.lastname: Quiñones
mesh_terms: D001783:Blood Flow Velocity; D015150:Echocardiography, Doppler; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000502:physiology*; D009200:Myocardial Contraction; D015203:Reproducibility of Results; D016276:Ventricular Function; D017725:Ventricular Pressure