title: Serial Doppler echocardiography and tissue Doppler imaging in the detection of elevated directly measured left atrial pressure in ambulant subjects with chronic heart failure.
abstract: OBJECTIVE
  This study sought to determine the accuracy of Doppler echocardiography and tissue Doppler imaging (TDI) measurements in detecting elevated left atrial pressure (LAP) in ambulant subjects with chronic heart failure using directly measured LAP as the reference.
  
  
  BACKGROUND
  Echocardiographic indexes including the ratio of transmitral to annular early diastolic velocities (E/e') may identify raised invasively measured left ventricular filling pressures when tested in cross-sectional studies in some populations. The accuracy of these indexes when measured sequentially remains untested. We determined the accuracy of Doppler echocardiography and TDI measurements in detecting elevated directly measured LAP in ambulant subjects with stable chronic heart failure.
  
  
  METHODS
  Fifteen patients with New York Heart Association functional class II to III heart failure and a permanently implanted direct LAP monitoring device underwent serial echocardiography. Simultaneous resting mean LAP, Doppler mitral inflow, mitral annular TDI, and pulmonary venous inflow velocities were obtained on each occasion. Receiver-operator characteristic curve analysis was used to compare the accuracy of the Doppler variables to detect an elevated device LAP ≥15 and ≥20 mm Hg.
  
  
  RESULTS
  The patients (13 men, mean age: 71 years, mean left ventricular ejection fraction: 32 ± 12%) underwent 60 simultaneous echocardiographic studies and LAP measurements with a median of 4 (1 to 7) studies per patient. Mean LAP was 16.9 (range 5 to 39 mm Hg) at echocardiography (n = 60). E/e' had the greatest accuracy for detection of LAP ≥15 mm Hg with an area beneath the receiver-operator characteristic curve >0.9. In comparison, area under the curve for mitral E velocity and mitral E/A were 0.77 and 0.76, respectively (p < 0.008 vs. E/e' medial and average).
  
  
  CONCLUSIONS
  Single and serial measurements of mitral inflow and mitral annular TDI velocities (E/e') can reliably detect raised directly measured LAP in ambulant subjects with compensated chronic heart failure. (Hemodynamically Guided Home Self-Therapy in Severe Heart Failure Patients [HOMEOSTASIS]; NCT00547729).
authors.affiliation: Department of Medicine, University of Otago, Christchurch, New Zealand. jayritzema@gmail.com
authors.forename: Jay L
authors.initials: JL
authors.lastname: Ritzema
authors.forename: A Mark
authors.initials: AM
authors.lastname: Richards
authors.forename: Ian G
authors.initials: IG
authors.lastname: Crozier
authors.forename: Christopher F
authors.initials: CF
authors.lastname: Frampton
authors.forename: Iain C
authors.initials: IC
authors.lastname: Melton
authors.forename: Robert N
authors.initials: RN
authors.lastname: Doughty
authors.forename: James T
authors.initials: JT
authors.lastname: Stewart
authors.forename: Neal
authors.initials: N
authors.lastname: Eigler
authors.forename: James
authors.initials: J
authors.lastname: Whiting
authors.forename: William T
authors.initials: WT
authors.lastname: Abraham
authors.forename: Richard W
authors.initials: RW
authors.lastname: Troughton
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016279:Atrial Function, Left; D002908:Chronic Disease; D015150:Echocardiography, Doppler; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology; D018670:Monitoring, Ambulatory / Q000295:instrumentation; D011237:Predictive Value of Tests; D011312:Pressure; D012372:ROC Curve; D013318:Stroke Volume; D013997:Time Factors; D016277:Ventricular Function, Left