Impact of mitral E/A ratio on the accuracy of different echocardiographic indices to estimate left ventricular end-diastolic pressure

Abstract The objective was to determine the influence of left ventricular (LV) inflow pattern on the accuracy of different echocardiographic indices for estimation of LV end-diastolic pressure (LVEDP). Echocardiography with color tissue Doppler imaging (TDI) and LVEDP measurements using fluid-filled catheters were performed in 176 consecutive patients on the same day. Mitral peak diastolic velocities (E, A) and the difference in duration between pulmonary venous retrograde velocity and mitral A-velocity (PV R –A) were recorded by pulsed Doppler. Propagation velocity of the early mitral inflow (V P ) was assessed using color M-mode. Early diastolic longitudinal (E′ lat ) and radial (E′ radial ) velocities of mitral annulus were measured by TDI. Area under ROC curve (AUC) for prediction of elevated LVEDP (≥15 mm Hg) was computed for each parameter. For E/A ≥1 (98 patients, 46 with elevated LVEDP), the AUC values were: PV R –A: 0.914; E/E′ lat : 0.780; E/E′ radial : 0.729; E/V P : 0.712 ( p R –A reached statistical significance (AUC = 0.893, p R –A enabled the most accurate noninvasive estimation of LVEDP irrespective of LV filling profile and combined indices E/V P , E/E′ lat and E/E′ radial represent more feasible alternatives for patients with mitral E/A–1. (E-mail: tpoerner@googlemail.com )