A novel index combining diastolic and systolic Tissue Doppler parameters for the non-invasive assessment of left ventricular end-diastolic pressure

Abstract Background Early diastolic transmitral velocity ( E )/early mitral annular diastolic velocity ( E a) ratio has been proposed as the best Doppler predictor for evaluating left ventricular (LV) filling pressure. Purpose To evaluate the relationship between a novel echocardiographic index, E /( E a × S a), and left ventricular end-diastolic pressure (LVEDP); S a is the peak systolic mitral annular velocity. We measured this index at different sites of the mitral annulus and compared it with other Tissue Doppler parameters. Methods Echocardiography was performed simultaneously with left heart catheterization in 110 consecutive patients in sinus rhythm. E , S a, E a and A a (late mitral annular diastolic velocity) were determined at medial and lateral site, and average values obtained. E / E a and E /( E a × S a) were calculated (medial, lateral, average). LVEDP was measured with invasively fluid-filled catheter. Results We demonstrated significant correlations between LVEDP and E /( E a × S a)lateral ( r = 0.78, p < 0.0001), E / E aaverage ( r = 0.70, p < 0.0001), E / E alateral ( r = 0.66, p < 0.0001), E / E amedial ( r = 0.60, p < 0.0001) and E /( E a × S a)medial ( r = 0.60, p < 0.0001). E /( E a × S a)average had the strongest correlation with LVEDP ( r = 0.80, p < 0.0001). An E /( E a × S a)average cut-off of 1.6 had 86% sensitivity and 85% specificity for detecting LVEDP> 15 mmHg. Weaker correlations were found for S a, E a and A a. E /( E a × S a)average was the best parameter to assess LVEDP in patients with normal LV ejection fraction (LVEF ≥ 50%) ( r = 0.83, p < 0.0001), depressed LVEF ( r = 0.76, p < 0.0001), regional dysfunction ( r = 0.81, p < 0.0001), or E / E aaverage between 8 and 15 ( r = 0.67, p < 0.0001). Conclusions E /( E a × S a)average was the best predictor of LVEDP in sinus rhythm patients, regardless of LVEF, particularly in those with E / E aaverage between 8 and 15 and in those with regional dysfunction.