Letter by Nagueh et al Regarding Article, “Tissue Doppler Imaging in the Estimation of Intracardiac Filling Pressure in Decompensated Patients With Advanced Systolic Heart Failure”

Abstract

To the Editor: We read with interest the article by Mullens et al,1 which reported that, in patients with decompensated systolic heart failure, the early transmitral velocity to tissue Doppler mitral annular early diastolic velocity (E/Ea) ratio may not be reliable in predicting filling pressures, especially in patients with larger left ventricular volumes, lower cardiac indices, and cardiac resynchronization therapy pacing. We want to express caution in interpreting these results because they contradict abundant data previously published and validated.2 Our concern is that the conclusions proffered may convey the wrong message about the use of E/Ea as a noninvasive estimate of filling pressures in patients with heart failure and left ventricular systolic dysfunction, in whom the ratio generally works well. The first major issue is the composition of …