A novel index combining diastolic and systolic Tissue Doppler parameters for the non-invasive assessment of left ventricular end-diastolic pressure.
BACKGROUND
Early diastolic transmitral velocity (E)/early mitral annular diastolic velocity (Ea) ratio has been proposed as the best Doppler predictor for evaluating left ventricular (LV) filling pressure.


OBJECTIVE
To evaluate the relationship between a novel echocardiographic index, E/(EaxSa), and left ventricular end-diastolic pressure (LVEDP); Sa is the peak systolic mitral annular velocity. We measured this index at different sites of the mitral annulus and compared it with other Tissue Doppler parameters.


METHODS
Echocardiography was performed simultaneously with left heart catheterization in 110 consecutive patients in sinus rhythm. E, Sa, Ea and Aa (late mitral annular diastolic velocity) were determined at medial and lateral site, and average values obtained. E/Ea and E/(EaxSa) were calculated (medial, lateral, average). LVEDP was measured with invasively fluid-filled catheter.


RESULTS
We demonstrated significant correlations between LVEDP and E/(EaxSa)(lateral) (r=0.78, p<0.0001), E/Ea(average) (r=0.70, p<0.0001), E/Ea(lateral) (r=0.66, p<0.0001), E/Ea(medial) (r=0.60, p<0.0001) and E/(EaxSa)(medial) (r=0.60, p<0.0001). E/(EaxSa)(average) had the strongest correlation with LVEDP (r=0.80, p<0.0001). An E/(EaxSa)(average) cut-off of 1.6 had 86% sensitivity and 85% specificity for detecting LVEDP>15 mmHg. Weaker correlations were found for Sa, Ea and Aa. E/(EaxSa)(average) was the best parameter to assess LVEDP in patients with normal LV ejection fraction (LVEF>or=50%) (r=0.83, p<0.0001), depressed LVEF (r=0.76, p<0.0001), regional dysfunction (r=0.81, p<0.0001), or E/Ea(average) between 8 and 15 (r=0.67, p<0.0001).


CONCLUSIONS
E/(EaxSa)(average) was the best predictor of LVEDP in sinus rhythm patients, regardless of LVEF, particularly in those with E/Ea(average) between 8 and 15 and in those with regional dysfunction.
Mornos
Cristian
C
Institute of Cardiovascular Diseases, Timisoara, Romania. mornoscristi@yahoo.com
Cozma
Dragos
D
Rusinaru
Dan
D
Ionac
Adina
A
Maximov
Daniela
D
Petrescu
Lucian
L
Dragulescu
Stefan-Iosif
SI
D000368:Aged; D006328:Cardiac Catheterization / Q000379:methods*; D003971:Diastole; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000502:physiology; D011237:Predictive Value of Tests; D012372:ROC Curve; D012044:Regression Analysis; D012680:Sensitivity and Specificity; D013599:Systole; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D016277:Ventricular Function, Left / Q000502:physiology; D017725:Ventricular Pressure / Q000502:physiology*