Noninvasive Estimation of Left Ventricular Diastolic Filling Pressure From Doppler Tei Index

Abstract

Background. Discrepancies between LV function and its filling pressure are typically characterized with severe dysfunction and normal filling pressure, suggesting reduced preload. Reduced preload can cause lower early to late diastolic mitral flow velocity ratio (E/A) on the Doppler echocardiogram. Therefore, we hypothesized that the relation between LV function and filling pressure is poorer in patients with mitral flow E/A < 1.0, however, the same relation is better in those with E/A ≥1.0.Objectives. The present study sought to investigate and compare the relation between LV filling pressure and indices of LV function, including the recently proposed Doppler Tei index, between patients with mitral flow E/A < 1.0 and those with the E/A ≥ 1.0.Methods. LV end-diastolic and mid-diastolic (before atrial contraction: pre-A) pressures were directly measured by catheterization in 74 consecutive patients with normal sinus rhythm. Tei index was measured from pulsed Doppler LV inflow and outflow velocity recordings, as the sum of isovolumetric contraction and relaxation time divided by LV ejection time. Indices of cardiac function including LV end-diastolic and end-systolic volumes, LV ejection fraction, left atrial dimension, mitral flow E/A, deceleration time of E velocity, and its slope were also measured by Doppler echocardiography.Results. In all subjects, there were no significant or relatively weak correlations between the LV filling pressures and indices of LV function (r2 = 0.05 ∼ 0.27, N.S. ∼ p < 0.0001). In patients with E/A < 1.0, the correlations were not significant for all indices of LV function. However, multiple indices of LV function, especially the Tei index, showed significant and better correlations with both LV end-diastolic and pre-A pressures (r2 = 0.66 and 0.63, p < 0.0001, respectively).Conclusions. Correlations between LV filling pressure and indices of LV function are worse and not significant in patients with mitral flow E/A < 1.0, however, the correlations are better and significant in patients with the E/A ≥ 1.0. Indices of LV function, especially Tei index, allows noninvasive estimation of LV diastolic filling pressure in patients with mitral E/A ≥ 1.0.