PURPOSE: N-terminal pro brain natriuretic peptide (NTproBNP) and the early diastolic transmitral velocity/early mitral annular diastolic velocity ratio (E/Ea) correlate to left ventricular filling pressures (LVFP), but these are not relevant in all patients.Purpose: to evaluate the optimal noninvasive assessment of LVFP (tissue Doppler echocardiography or NTproBNP).
METHODS: Conventional echocardiography , tissue Doppler imaging and NTproBNP were performed simultaneously with LV catheterization in 97 consecutive patients (pts) (age 63±13 years). Patients with inadequate echocardiographic images, congenital heart disease, paced rhythm, mitral stenosis, mitral prosthesis, significant primary or organic mitral regurgitation, pericardial disease, acute coronary syndrome, coronary artery by-pass within 72 hours or renal failure were excluded. E/Ea and E/(Ea×Sa) were calculated (where Sa is the maximal systolic velocity of mitral annulus during ejection); the average of the velocities from the septal and lateral site of the mitral annulus was used. LV end-diastolic pressure (LVEDP) were obtained with micromanometer-tipped catheters. The results were blinded to the interpreter.
RESULTS: The ability of E/Ea , E/(Ea×Sa) and NTproBNP to predict LVEDP > 15 mmHg was assessed with simple regression analysis and receiver-operating characteristic (ROC) analysis. The coefficient of linear correlation (r) and the area under ROC - curve (AUC) were maximal for the index E/(Ea×Sa) (AUC = 0.90, r = 0.80), followed by NTproBNP (AUC = 0.86, r = 0.74), E/Ea (AUC = 0.79, r = 0.68), p < 0.0001. Optimal cutoffs were 1,61 for E/(Ea×Sa) (sensitivity and specificity of 89% and 87%), 1213 pg/ml for NTproBNP (82% and 88%), and 10.7 for E/Ea (74% and 81%). E/(Ea×Sa) had a better correlation with LVEDP in pts with normal LV ejection fraction (EF ≥50%) (35 pts, r=0,83, p<0,0001) versus those with depressed EF (62 pts, r=0,75, p<0,0001).
CONCLUSION: E/(Ea×Sa) strongly correlates with LVEDP in patients in sinus rhythm and is better than E/Ea and NTproBNP levels to predict LVEDP.
CLINICAL IMPLICATIONS: E/(Ea×Sa) can be used to predict elevated LVEDP in patients with normal or depressed LVEF.
DISCLOSURE: Cristian Mornos, No Financial Disclosure Information; No Product/Research Disclosure Information