Combined Doppler index to track instantaneous changes in left ventricular filling pressure

Abstract

Objective — The ratio of early transmitral pulsed Doppler velocity (E) to colour M-mode Doppler flow propagation velocity (Vp) has been reported to be a good predictor of pulmonary capillary wedge pressure (PCWP) and left ventricular end-diastolic pressure (LVEDP). It is unknown whether E/Vp can be used to reflect the instantaneous haemodynamic change after drug intervention.Methods and results — The study population was composed of 19 patients who underwent elective cardiac catheterization for suspected coronary artery disease. Mean PCWP (mPCWP) obtained from right heart catheterization and LVEDP from a micromanometer-tipped catheter were compared with echocardiographic data before and 5 minutes after sublingual application of nitroglycerin (NTG) 0.6 mg. By stepwise multiple linear regression analysis, we found a positive correlation between mPCWP and E/Vp (b‚ = 0.687, p = 0.001) and LVEDP and E/Vp (b‚ = 0.718, p = 0.001).After NTG intake, the change in E/Vp was significantly correlated with the changes in mPCWP and LVEDP (r = 0.574, p = 0.010; r = 0.627, p = 0.004, respectively).Conclusions — In addition to being a useful predictor of mPCWP and LVEDP, the index, E/Vp, can be used to track the instantaneous changes in mPCWP and LVEDP.