Clinical Utility Of Doppler Echocardiography And Tissue Doppler Imaging In The Estimation Of Left Ventricular End-diastolic Pressures--A Comparative Simultaneous Doppler-Catheterization Study

Objective: This study was designed to assess whether the ratio of mitral velocity to early diastolic velocity of the mitral annulus(E/E')with coronary disease was associated with invasive measures of left ventricular end-diastolic pressure (LVEDP) and to select one or more valuable Doppler parameters for estimating of LVEDP.Methods: Thirty consecutive patients with coronary disease underwent transthoracic Doppler echocardiography within 24 hours before cardiac catheterization. Doppler signals from the mitral inflow, pulmonary venous inflow, and TDI of the mitral annulus were obtained. Invasive measurements of LVEDP were obtained with pig -tailed catheters.Results: Linear regression analysis showed the ratio of mitral velocity to early diastolic velocity of the mitral annulus (E/E') had the best correlation with LVEDP(S:r=0.739,p<0.01；L: r=0.710, p<0.01). in septal area E/E'≥10 predicted LVEDP≥15 mm Hg with a sensitivity of 85 %; a specificity of 89%; in lateral wall E/E' ≥10 predicted LVEDP≥15 mmHg with a sensitivity of 82%；a specificity of 90%。the difference in duration between the pulmonary venous A and mitral A wave (PAd-A d) had the better correlation with LVEDP(r=0.705,p<0.01)The duration of the pulonary venous A wave equalling or exceeding the duration of the mitral A wave ( that means PA d-A d≥0) predicted LVEDP≥15 mmHg with a sensitivity of 80%; a specificity of 86%. Conclusions: The ratio of mitral velocity to early diastolic velocity of the mitral annulus (E/E') and the difference in duration between the pulmonary venous A and mitral A wave provide more valuable parameters for estimating of LVEDP than other methods do. E/E' ≥10 and PAd-A d≥0 may provide a semi-quantitative index for predicting LVEDP (15 mmHg) elevation.