title: The origin and clinical significance of the signal opposite to the mitral E-wave: a simple and novel indicator of left ventricular filling pressure.
abstract: OBJECTIVE
  We noted a low-velocity signal opposite to the early diastolic transmitral flow (E) by pulsed Doppler echocardiography. The purpose of this study was to examine the origin and significance of this signal.
  
  
  BACKGROUND
  The background of the signal remains uncertain.
  
  
  METHODS
  We studied 59 adult patients (34 men and 25 women; mean age, 58.9 [20.2] years) without mitral valve heart disease. Mitral E-wave velocity and the signal (EW) opposite the E-wave were measured by pulsed Doppler echocardiography. Early diastolic mitral valve ring motion velocity (Ea) was measured by pulsed tissue Doppler echocardiography. Pulmonary capillary wedge pressure (PCWP) was measured by a Swan-Ganz catheter in 34 of the 59 patients.
  
  
  RESULTS
  A blue signal was observed during early diastole from the mitral valve ring to the mitral orifice areas by color tissue Doppler echocardiography. The velocity profile method revealed the same direction and time between peak Ea and EW. Peak EW positively correlated with Ea (r = 0.67, P < 0.01). There were significant positive correlations between mean PCWP and E/Ea (r = 0.61, P < 0.01) and E/EW (r = 0.59, P < 0.01). E/EW was significantly greater in patients with PCWP > 12 mmHg than in patients with PCWP ≤ 12 mmHg (5.6 [1.3] cm/s vs. 4.3 [0.9] cm/s, P < 0.01).
  
  
  CONCLUSIONS
  EW may be related to mitral valve ring motion, and the E/EW ratio may be a noninvasive simple parameter for assessing left ventricular filling pressure.
authors: Department of Cardiology Clinical Laboratory, Hiroshima Prefectural Hospital, Minami-ku, Hiroshima, Japan. yuko7@hiroshima-u.ac.jp
authors: Yuko
authors: Y
authors: Makita
authors: Mitsunori
authors: M
authors: Okamoto
authors: Naoyasu
authors: N
authors: Yoshida
authors: Masaki
authors: M
authors: Hashimoto
authors: Yumiko
authors: Y
authors: Shintani
authors: Kenta
authors: K
authors: Kajihara
authors: Yukiko
authors: Y
authors: Nakano
authors: Yasuki
authors: Y
authors: Kihara
mesh_terms: D001794:Blood Pressure; D001795:Blood Pressure Determination / Q000379:methods*; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging*; D017725:Ventricular Pressure / Q000502:physiology*