Value of conventional and tissue Doppler echocardiography in the estimation of left ventricular filling pressure

BackgroundVarious conventional and tissue Doppler parameters have been proposed for the estimation of left ventricular filling pressure.AimTo assess the utility of several conventional and tissue Doppler parameters in the estimation of left ventricular end diastolic pressure (LVEDP).MethodAmong 40 consecutive patients LVEDP was correlated with pulsed Doppler of mitral inflow and pulsed tissue Doppler of lateral mitral annulus.ResultsAmong all studied Doppler variables, E′/A′ ratio showed the most significant correlation with LVEDP (r = 0.612, p < 0.001). Among patients with grade II and III diastolic dysfunction, E′/A′ ratio showed the best correlation with LVEDP (r = 0.81, p < 0.001) with the following regression equation: LVEDP = 1.77 + (20.4 × E′/A′) while in patients with grade I diastolic dysfunction no correlation exists (r = 0.11, p = 0.63). Weak significant correlation was detected between E/E′ ratio and LVEDP (r = 0.382, p = 0.016). An E/E′ ratio > 12 had 25% sensitivity and 100% specificity to identify patients with elevated LVEDP (>15 mm Hg) with a positive predictive value of 100%. On the other hand, an E/E′ ratio of <8 had 77% sensitivity and 57% specificity to identify patients with normal LVEDP with a negative predictive value of 31%.ConclusionOf all echocardiographic variables investigated, E′/A′ ratio was identified as the best index to estimate LVEDP especially in patients with advanced LV diastolic dysfunction; a relation that was not found for other conventional or tissue Doppler variables including the E/E′ ratio.