The E/e filling index and right ventricular pressure in relation to applied international Doppler recommendations of left ventricular filling assessment.
OBJECTIVE
A ratio>15 between the early diastolic pulsed Doppler velocities of the mitral inflow (E) and the basal left ventricular (LV) tissue (e) has been demonstrated to predict an elevated LV filling pressure (FP). An elevated LVFP implies an elevated right ventricular pressure (RVp). In order to investigate the sensitivity of the E/e filling index, we compared E/e and RVp, in their ability to identify a Doppler-assumed elevation of LVFP.


RESULTS
Application of pulsed Doppler international recommendations grouped 134 patients with acute coronary syndromes (ACS) and 50 age- and sex-matched controls, according to LV filling: normal; delayed relaxation; an isolated pathological mitral-pulmonary venous-A-wave-duration difference; pseudo normal; or a restrictive filling pattern. An E/e>15 and an RVp>30 mmHg showed the following (%) sensitivity (32/94), specificity (95/76), positive (68/59), and negative (80/97) predictive values of a Doppler-assumed elevation of LVFP, in terms of either a pseudo normal or a restrictive filling pattern.


CONCLUSIONS
The low sensitivity of E/e to detect a Doppler-assumed elevation of LVFP could limit its clinical usefulness as a single variable, in ACS. The high sensitivity and negative predictive value of RVp support its use as an additional LV filling variable in these patients.
Wallentin Guron
Cecilia
C
Department of Clinical Physiology, Sahlgrenska University Hospital, SE 416 85 Göteborg, Sweden. c.wallentin@home.se
Bech-Hanssen
Odd
O
Wikh
Ronny
R
Rosengren
Annika
A
Hartford
Marianne
M
Caidahl
Kenneth
K
D000368:Aged; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000503:physiopathology; D018619:Echocardiography, Doppler, Pulsed; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000502:physiology; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016276:Ventricular Function; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right; D017725:Ventricular Pressure