title: Usefulness of tissue Doppler imaging for assessing left ventricular filling pressure in patients with stable severe systolic heart failure.
abstract: The ratio of early transmitral blood flow velocity over tissue Doppler early diastolic mitral annulus velocity (E/e') was found unreliable for estimating pulmonary capillary wedge pressure (PCWP) in patients with decompensated systolic heart failure (HF). The objective of this study was to test its reliability in stable HF. Therefore, 130 consecutive patients with a left ventricular (LV) ejection fraction of <35% and stable HF underwent right-sided cardiac catheterization and transthoracic echocardiography with measurement of transmitral flow velocities (E, A) and mitral annulus velocities during systole (s') and diastole (e'). Mean age was 56 ± 11 years and mean LV ejection fraction was 28 ± 8%; 48% had PCWP of >15 mm Hg. E/e'septal correlated more strongly with PCWP (r = 0.53) compared with E/e'lateral (r = 0.41) and E/e'mean (r = 0.50; all p values <0.001). The area under the receiver operating characteristic curve (AUC) of E/e' ratios for PCWP estimation was 0.79 (95% confidence interval [CI] 0.70 to 0.87) for E/e'septal, 0.72 (95% CI 0.63 to 0.82) for E/elateral, and 0.79 (95% CI 0.70 to 0.87) for E/emean (all p values <0.0001). AUCs of E/eseptal and E/emean did not vary with s'septal, QRS width, or resynchronization. Using a cutoff of 8, negative predictive value of E/e'septal was 89% and negative likelihood ratio of 0.15. E/e'lateral showed good diagnostic performance only in patients with s'lateral of >4.5 cm/s (n = 77, 59%; AUC = 0.82; 95% CI 0.71 to 0.92; s'lateral of ≤4.5 cm/s: AUC = 0.54; 95% CI 0.38 to 0.70; p = 0.005). In conclusion, e' is useful for estimating LV filling pressure in stable severe systolic HF. E/e'septal showed good diagnostic performance for detecting normal filling pressures.
authors.affiliation: Department of Cardiology, Henri Mondor University Hospital, Université Paris Est, Assistance Publique-Hôpitaux de Paris, Créteil, France; Department of Cardiac Rehabilitation, Albert Chenevier University Hospital, Université Paris Est, Assistance Publique-Hôpitaux de Paris, Créteil, France; Department of Physiology, Henri Mondor University Hospital, Université Paris Est, Assistance Publique-Hôpitaux de Paris, Créteil, France. Electronic address: barnabas.gellen@hmn.aphp.fr.
authors.forename: Barnabas
authors.initials: B
authors.lastname: Gellen
authors.forename: Florence
authors.initials: F
authors.lastname: Canoui-Poitrine
authors.forename: Pierre-François
authors.initials: PF
authors.lastname: Lesault
authors.forename: Aurélie
authors.initials: A
authors.lastname: Le Thuaut
authors.forename: Pascal
authors.initials: P
authors.lastname: Lim
authors.forename: Pascal
authors.initials: P
authors.lastname: Gueret
authors.forename: Soulef
authors.initials: S
authors.lastname: Guendouz
authors.forename: Dionyssis
authors.initials: D
authors.lastname: Pongas
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Teiger
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Dubois-Randé
authors.forename: Luc
authors.initials: L
authors.lastname: Hittinger
authors.forename: Thibaud
authors.initials: T
authors.lastname: Damy
mesh_terms: D006328:Cardiac Catheterization; D004452:Echocardiography; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D054143:Heart Failure, Systolic / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013318:Stroke Volume; D016277:Ventricular Function, Left; D017725:Ventricular Pressure / Q000502:physiology*