PURPOSE: Peak early diastolic transmitral velocity (using pulsed Doppler) / peak early mitral annular diastolic velocity (using pulsed tissue Doppler imaging –TDI) ratio (E/Ea) can be used to group patients according to filling pressures, but the intermediate group ( E/Ea = 8 –15) requires additional information to correctly classify the left ventricular filling pressures(LVFP). Purpose: To assess the relationship between a new echocardiographic parameter, E/(Ea×Sa), where Sa is the peak systolic velocity in TDI of mitral annulus, and LVFP in patients with E/Ea between 8 and 15.
METHODS: Conventional echocardiography and TDI were performed simultaneously with left heart catheterization in 97 patients (pts) in sinus rhythm. Patients with inadequate echocardiographic images, paced rhythm, mitral stenosis, mitral prosthesis, significant organic mitral regurgitation, pericardial disease, acute myocardial infarction or coronary artery by-pass within 72 hours were excluded. E/Ea and E/(Ea×Sa) were calculated; the average of the velocities from the septal and lateral site of the mitral annulus was used.Only 55 pts (age 64±13 years) with E/Ea between 8 and 15 formed the study group. LV end-diastolic pressure (LVEDP) was measured invasively with fluid-filled catheter.
RESULTS: Simple regression analysis demonstrated a statistically significant linear correlation between E/(Ea×Sa) and LVEDP (r=0,68, p<0,0001), superior to E/Ea correlation (r=0,46, p<0,001). The area under the receiver-operating characteristic curve (ROC) for E/(Ea×Sa) to detect LVEDP >15 mmHg was 0.95 (95% confidence interval - CI, p<0,0001) versus 0.79 (95% CI, p<0,001) for E/Ea. A E/(Ea×Sa) cut-off value of 1,5 had a sensitivity of 83% , a specificity of 79% and an accuracy of 80% for detecting LVEDP>15 mmHg. E/(Ea×Sa) had a better correlation with LVEDP in pts with normal LV ejection fraction (EF>50%) (18 pts, r=0,68, p=0,001) versus those with depressed LVEF (37 pts, r=0,61, p<0,001).
CONCLUSION: The E/(Ea×Sa) ratio can be used to predict LVFP with reasonable accuracy in patients with E/Ea ratio 8 to 15 in sinus rhythm, with or without depressed LVEF.
CLINICAL IMPLICATIONS: DTI is usefull to estimate LVFP in patients with intermediate E/Ea.
DISCLOSURE: Cristian Mornos, None.