Is E/E' reliable in patients with regional wall motion abnormalities to estimate left ventricular filling pressure?
BACKGROUND
There is limited data on the diagnostic utility of the transmitral to mitral annular velocity (E/E') by tissue Doppler imaging (TDI) in the presence of regional wall motion abnormalities (RWMA). We aimed to investigate whether the E/E' is reliable in estimating left ventricular filling pressure (LVFP) despite RWMA.


METHODS
One hundred thirty consecutive patients with myocardial infarction (MI) and subsequent RWMA referred for cardiac catheterization and echocardiography to measure LV pre-A pressure (LVP(PRE-A)) and Doppler signals from the mitral inflow with tissue Doppler imaging (TDI) of the mitral annulus. All patients were classified into three groups according to RWMA of the segment adjacent to the E'-measuring point using TDI: 83 patients with normal wall motions of the basal septal and basal lateral segments (group A); 28 patients with RWMA of the basal septum (group B); and 19 patients with RWMA of the basal lateral segment (group C).


RESULTS
Septal E/E' correlated with LVP(PRE-A) in groups A and C (r = 0.383, P < 0.001; r = 0.482, P = 0.037, respectively). Lateral E/E' and LVP(PRE-A) showed good correlation in groups A, B and C (r = 0.470, P < 0.001; r = 0.416, P = 0.028; r = 0.727, P < 0.001, respectively). The largest area under the receiver operating curve was obtained by the lateral E/E' for the prediction of a high LVFP, irrespective of the location of RWMA.


CONCLUSIONS
In selected patients with abnormal wall motion of the basal septum, E/E' measured at the septum was not representative for LVFP. Lateral E/E' is reliable for the prediction of high LVFP, regardless of the site of RWMA.
Lim
Hong-Seok
HS
Ajou University Medical Center, Suwon, Korea.
Kang
Soo-Jin
SJ
Choi
Jung-Hyun
JH
Ahn
Sung-Gyun
SG
Choi
Byoung-Joo
BJ
Choi
So-Yeon
SY
Yoon
Myeong-Ho
MH
Hwang
Gyo-Seung
GS
Tahk
Seung-Jea
SJ
Shin
Joon-Han
JH
D000704:Analysis of Variance; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology*; D012372:ROC Curve; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D017725:Ventricular Pressure / Q000502:physiology*