Validation of six noninvasive Doppler methods for the assessment of left ventricular filling pressure.
OBJECTIVE
The aim of this study was to determine the accuracy of six noninvasive Doppler methods for assessing invasively derived left ventricular diastolic pressure (LVDP).


BACKGROUND
To date, no studies have evaluated which of the various available Doppler methods are most reliable in determining LVDP in a consecutive patient population with different cardiac diseases.


METHODS
LVDP was estimated by the following Doppler methods (M): (1) M1-the peak mitral regurgitant flow velocity (peak MR), (2) M2-the mitral regurgitant velocity at the time of aortic valve opening (MRAVO), (3) M3-the aortic regurgitant end-diastolic flow velocity (ARED), (4) M4-the ratio of the transmitral to mitral annular early diastolic velocity (ETM/EDTI), (5) M5-a transmitral flow velocity regression equation (RegrTM), and (6) M6-the difference of pulmonary venous and transmitral A wave duration (APV - ATM duration). For M1-M3, sphygmomanometric blood pressure was used to calculate LVDP.


RESULTS
In 101 patients, the regression coefficient, standard error of estimate, and mean difference with confidence limits between Doppler and catheter-derived measurements were as follows: M1 (n = 46): r = 0.81 (P < 0.0001), 4.3 mmHg and 3.7 +/- 12.0 mmHg; M2 (n = 47): r = 0.79 (P < 0.0001), 5.4 mmHg and 1.1 +/- 11.2 mmHg; M3 (n = 20): r = 0.64 (P = 0.002), 7.8 mmHg and 4.6 +/- 17.6 mmHg; M4 (n = 50): r = 0.62 (P < 0.0001), 5.6 mmHg and 0 +/- 11.2 mmHg; M5 (n = 79): r = 0.24 (P = 0.03), 7.1 mmHg and - 0.1 +/- 16.8 mmHg; and M6 (n = 79): r = 0.22 (P = 0.05), 7.3 mmHg and 0 +/- 14.4 mmHg, respectively.


CONCLUSIONS
The Doppler measurement of mitral regurgitant jets is most accurate method to estimate left ventricular filling pressure noninvasively.
Kucher
Nils
N
Swiss Cardiovascular Center, Bern, University Hospital, 3010 Bern, Switzerland. christian.seiler.cardio@insel.ch
Schwerzmann
Markus
M
Lipp
Ernst
E
Eyer
David
D
Meier
Bernhard
B
Seiler
Christian
C
D000368:Aged; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000503:physiopathology; D009202:Cardiomyopathies / Q000175:diagnosis / Q000503:physiopathology; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000503:physiopathology; D003971:Diastole / Q000502:physiology; D015150:Echocardiography, Doppler; D005240:Feasibility Studies; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000503:physiopathology; D012372:ROC Curve; D012044:Regression Analysis; D012720:Severity of Illness Index; D013223:Statistics as Topic; D013318:Stroke Volume / Q000502:physiology; D013599:Systole / Q000502:physiology; D016277:Ventricular Function, Left / Q000502:physiology*; D017725:Ventricular Pressure / Q000502:physiology*