Value of conventional and tissue Doppler echocardiography in the estimation of left ventricular filling pressure

Background: Various conventional and tissue Doppler parameters have been proposed for the estimation of left ventricular filling pressure.Aim: To assess the utility of several conventional and tissue Doppler parameters in the estimation of left ventricular end diastolic pressure (LVEDP).Method: Among 40 consecutive patients LVEDP was correlated with pulsed Doppler of mitral inflow and pulsed tissue Doppler of lateral mitral annulus.Results: Among all studied Doppler variables, E'/A' ratio showed the most significant correlation with LVEDP ( r = 0.612, p < 0.001). Among patients with grade II and III diastolic dysfunction, E'/A' ratio showed the best correlation with LVEDP ( r = 0.81, p < 0.001) with the following regression equation: LVEDP = 1.77 + ( 20.4 x E'/A') while in patients with grade I diastolic dysfunction no correlation exists ( r = 0.11, p = 0.63). Weak significant correlation was detected between E/E' ratio and LVEDP ( r = 0.382, p = 0.016). An E/E' ratio > 12 had 25% sensitivity and 100% specificity to identify patients with elevated LVEDP (> 15 mm Hg) with a positive predictive value of 100%. On the other hand, an E/E' ratio of < 8 had 77% sensitivity and 57% specificity to identify patients with normal LVEDP with a negative predictive value of 31%.Conclusion: Of all echocardiographic variables investigated, E'/A' ratio was identified as the best index to estimate LVEDP especially in patients with advanced LV diastolic dysfunction; a relation that was not found for other conventional or tissue Doppler variables including the E/E' ratio. (C) 2012 Egyptian Society of Cardiology. Production and hosting by Elsevier B.V. All rights reserved.