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

Abstract

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 (PV R–A) were recorded by pulsed Doppler. Propagation velocity of the early mitral inflow (V P) 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: PV R–A: 0.914; E/E′ lat: 0.780; E/E′ radial: 0.729; E/V P: 0.712 ( p < 0.001). When E/A <1 (78 patients, 26 with elevated LVEDP), only PV R–A reached statistical significance (AUC = 0.893, p < 0.001). The conclusions were: PV R–A enabled the most accurate noninvasive estimation of LVEDP irrespective of LV filling profile and combined indices E/V P, E/E′ lat and E/E′ radial represent more feasible alternatives for patients with mitral E/A–1. (E-mail: tpoerner@googlemail.com)