Comparative value of tissue Doppler imaging and m-mode color Doppler mitral flow propagation velocity for the evaluation of left ventricular filling pressure.
BACKGROUND
Recently, two new indexes based on the ratio of transmitral early diastolic velocity (E) to tissue Doppler imaging (TDI), and early diastolic velocity of mitral annulus (E') and E to propagation velocity (Vp) have been proposed to predict left ventricular (LV) filling pressures. However, little is known about the comparative value of these two indexes.


METHODS
We studied 71 consecutive patients referred for coronary angiography (mean age +/- SD, 65 + 11 years; 21 patients with LV ejection fraction [EF] < 50%). Complete Doppler echocardiographic examination including TDI and Vp measurements and direct measurement of LV end-diastolic pressure (LVEDP) were performed simultaneously in the catheterization laboratory. LV filling pressures were considered elevated when LVEDP was > or = 15 mm Hg.


RESULTS
The correlation coefficients between E/E' and E/Vp and LVEDP were 0.68 (p = 0.01) and 0.54 (p = 0.01), respectively, in the overall population. The correlations were better in patients with low LV EF (< 50%) [0.8 (p = 0.01) and 0.77(p = 0.01)] and poor in patients with normal LV EF (0.57 [p = 0.05] and 0.41 [not significant]), respectively. Moreover, Vp measurements had higher interobserver variability compared to E' (14% vs 7%). The cutoff values for both indexes giving the best sensitivity and specificity in identifying LVEDP > or = 15 mm Hg were 9 for (E/E') and 2 for (E/Vp).


CONCLUSIONS
Both E/E' and E/Vp can be used for the evaluation of LV filling pressures. However, the sensitivity of these indexes, especially E/Vp, is hampered by EF. E/E' has a lower variability than Vp and should be preferred for estimation of filling pressures especially in patients with EF > 50%.
Kidawa
Michal
M
Department of Cardiology, Medical University of Łódź, Poland, Biegański Hospital, Ul. Kniaziewicza 1/5, 91-347 Łódź, Poland. mkidawa@wp.pl
Coignard
Lisa
L
Drobinski
Gérard
G
Krzeminska-Pakula
Maria
M
Thomas
Daniel
D
Komajda
Michel
M
Isnard
Richard
R
D000368:Aged; D001783:Blood Flow Velocity; D001794:Blood Pressure; D017023:Coronary Angiography; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging*; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D018615:Ultrasonography, Doppler, Color