Correlation of Invasively Estimated Left Ventricular End Diastolic Pressure with Acceleration of E’ Wave by Tissue Doppler Imaging of Mitral Annulus

Background: There is no single noninvasive index that provides a direct measure of LV filling pressure. However, invasive measuring of LV end diastolic pressure (LVEDP) provides reliable assessment of LV diastolic dysfunction, but its invasive nature limits its use in daily practice. Accurate noninvasive assessment of LV diastolic dysfunction is highly desirable, and the relationship between the degree of LVEDP and acceleration of E’ wave obtained by tissue Doppler imaging (TDI) of mitral annulus is not clearly assessed; here in our study we aimed to assess the relation between the degree of LVEDP and the acceleration rate of E’ wave of mitral annular Doppler tissue. Patients and Methods: The study included 60 patients divided equally into 3 groups according to the degree of LVEDP, group I (Normal): <10 mmHg, group II (Grey zone): 10 - 14 mmHg, and group III (Elevated): ≥15 mmHg. All participants underwent Electrocardiographic examination (ECG), standard two-dimensional echocardiography, mitral Doppler flow and tissue Doppler imaging of mitral annulus including E/E’ ratio and E’ wave acceleration rate. Coronary angiography and left sided heart catheterization and measuring LVEDP were performed for correlating E’ wave acceleration rate with invasively estimated LVEDP. Results: There was significant progressive decrease in E’ acceleration rate (E’ Acc rate) with progressive increase in LVEDP from I to III (P 0.001), while there was significant progressive increase in E/E’ ratio with progressive increase in LVEDP from I to III (P 0.003). Peak E’ acceleration rate had a significant negative correlation with LVEDP in all three groups, with p value of 0.003, 0.044 and 0.021 respectively in group I, II & III. Regarding E/E’ ratio there was a significant positive correlation in predicting normal and elevated LVEDP with p value (0.001 and 0.006) respectively while there was a non-significant correlation between E/E’ and LVEDP within grey zone group. Conclusion: E’ acceleration rate could be used as a reliable index to assess LVEDP.