title: Tissue Doppler imaging in the estimation of intracardiac filling pressure in decompensated patients with advanced systolic heart failure.
abstract: BACKGROUND
  The ratio of early transmitral velocity to tissue Doppler mitral annular early diastolic velocity (E/Ea) has been correlated with pulmonary capillary wedge pressure (PCWP) in a wide variety of cardiac conditions. The objective of this study was to determine the reliability of mitral E/Ea for predicting PCWP in patients admitted for advanced decompensated heart failure.
  
  
  RESULTS
  Prospective consecutive patients with advanced decompensated heart failure (ejection fraction < or =30%, New York Heart Association class III to IV symptoms) underwent simultaneous echocardiographic and hemodynamic evaluation on admission and after 48 hours of intensive medical therapy. A total of 106 patients were included (mean age, 57+/-12 years; ejection fraction, 24+/-8%; PCWP, 21+/-7 mm Hg; mitral E/Ea ratio, 20+/-12). No correlation was found between mitral E/Ea ratio and PCWP, particularly in those with larger left ventricular volumes, more impaired cardiac indexes, and the presence of cardiac resynchronization therapy. Overall, the mitral E/Ea ratio was similar among patients with PCWP >18 and < or =18 mm Hg, and sensitivity and specificity for mitral E/Ea ratio >15 to identify a PCWP >18 mm Hg were 66% and 50%, respectively. Contrary to prior reports, we did not observe any direct association between changes in PCWP and changes in mitral E/Ea ratio.
  
  
  CONCLUSIONS
  In decompensated patients with advanced systolic heart failure, tissue Doppler-derived mitral E/Ea ratio may not be as reliable in predicting intracardiac filling pressures, particularly in those with larger LV volumes, more impaired cardiac indices, and the presence of cardiac resynchronization therapy.
authors.affiliation: Section of Heart Failure and Cardiac Transplantation Medicine, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
authors.forename: Wilfried
authors.initials: W
authors.lastname: Mullens
authors.forename: Allen G
authors.initials: AG
authors.lastname: Borowski
authors.forename: Ronan J
authors.initials: RJ
authors.lastname: Curtin
authors.forename: James D
authors.initials: JD
authors.lastname: Thomas
authors.forename: W H
authors.initials: WH
authors.lastname: Tang
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure; D002302:Cardiac Output; D015150:Echocardiography, Doppler / Q000379:methods* / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D054143:Heart Failure, Systolic / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000502:physiology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011669:Pulmonary Wedge Pressure; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity