A novel index combining diastolic and systolic Tissue Doppler parameters for the non-invasive assessment of left ventricular end-diastolic pressure

Abstract 

Background

Early diastolic transmitral velocity (E)/early mitral annular diastolic velocity (Ea) ratio has been proposed as the best Doppler predictor for evaluating left ventricular (LV) filling pressure.

Purpose

To evaluate the relationship between a novel echocardiographic index, E/(Ea×Sa), and left ventricular end-diastolic pressure (LVEDP); Sa is the peak systolic mitral annular velocity. We measured this index at different sites of the mitral annulus and compared it with other Tissue Doppler parameters.

Methods

Echocardiography was performed simultaneously with left heart catheterization in 110 consecutive patients in sinus rhythm. E, Sa, Ea and Aa (late mitral annular diastolic velocity) were determined at medial and lateral site, and average values obtained. E/Ea and E/(Ea×Sa) were calculated (medial, lateral, average). LVEDP was measured with invasively fluid-filled catheter.

Results

We demonstrated significant correlations between LVEDP and E/(Ea×Sa)_lateral (r=0.78, p<0.0001), E/Ea_average (r=0.70, p<0.0001), E/Ea_lateral (r=0.66, p<0.0001), E/Ea_medial (r=0.60, p<0.0001) and E/(Ea×Sa)_medial (r=0.60, p<0.0001). E/(Ea×Sa)_average had the strongest correlation with LVEDP (r=0.80, p<0.0001). An E/(Ea×Sa)_average cut-off of 1.6 had 86% sensitivity and 85% specificity for detecting LVEDP>15 mmHg. Weaker correlations were found for Sa, Ea and Aa. E/(Ea×Sa)_average was the best parameter to assess LVEDP in patients with normal LV ejection fraction (LVEF≥50%) (r=0.83, p<0.0001), depressed LVEF (r=0.76, p<0.0001), regional dysfunction (r=0.81, p<0.0001), or E/Ea_average between 8 and 15 (r=0.67, p<0.0001).

Conclusions

E/(Ea×Sa)_average was the best predictor of LVEDP in sinus rhythm patients, regardless of LVEF, particularly in those with E/Ea_average between 8 and 15 and in those with regional dysfunction.

Abbreviations: Aa, maximal late mitral annular diastolic velocity, E, maximal early diastolic transmitral flow velocity, Ea, maximal early mitral annular diastolic velocity, EF, ejection fraction, LV, left ventricle, LVEDP, left ventricular end-diastolic pressure, Sa, maximal systolic velocity of mitral annulus, TDI, Tissue Doppler imaging

Keywords: Left ventricular end-diastolic pressure, Mitral annulus velocity, Tissue Doppler imaging