Impact of Mitral E/A Ratio on the Accuracy of Different Echocardiographic Indices to Estimate Left Ventricular End-Diastolic Pressure

The objective was to determine the influence of left ventricular (LV) inflow pattern on the accuracy of different echocardiographic indices for estimation of LV end-diastolic pressure (LVEDP). Echocardiography with color tissue Doppler imaging (TDI) and LVEDP measurements using fluid-filled catheters were performed in 176 consecutive patients on the same day. Mitral peak diastolic velocities (E, A) and the difference in duration between pulmonary venous retrograde velocity and mitral A-velocity (PVR-A) were recorded by pulsed Doppler. Propagation velocity of the early mitral inflow (VP) was assessed using color M-mode. Early diastolic longitudinal (E′lat) and radial (E′radial) velocities of mitral annulus were measured by TDI. Area under ROC curve (AUC) for prediction of elevated LVEDP (≥15 mm Hg) was computed for each parameter. For E/A ≥1 (98 patients, 46 with elevated LVEDP), the AUC values were: PVR-A: 0.914; E/E′lat: 0.780; E/E′radial: 0.729; E/VP: 0.712 (p < 0.001). When E/A <1 (78 patients, 26 with elevated LVEDP), only PVR-A reached statistical significance (AUC = 0.893, p < 0.001). The conclusions were: PVR-A enabled the most accurate noninvasive estimation of LVEDP irrespective of LV filling profile and combined indices E/VP, E/E′lat and E/E′radial represent more feasible alternatives for patients with mitral E/A-1. (E-mail: tpoerner@googlemail.com)