Clinical Utility of Doppler Echocardiography and Tissue Doppler Imaging in the Estimation of Left Ventricular Filling Pressures : A Comparative Simultaneous Doppler-Catheterization Study
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Abstract
Noninvasive assessment of diastolic filling by Doppler echocardiography provides important
information about left ventricular (LV) status in selected subsets of patients. This
study was designed to assess whether mitral annular velocities as assessed by tissue
Doppler imaging are associated with invasive measures of diastolic LV performance
and whether additional information is gained over traditional Doppler variables.
One hundred consecutive patients referred for cardiac catheterization underwent simultaneous
Doppler interrogation. Invasive measurements of LV pressures were obtained with micromanometer-tipped
catheters, and the mean LV diastolic pressure (M-LVDP) was used as a surrogate for
mean left atrial pressure. Doppler signals from the mitral inflow, pulmonary venous
inflow, and TDI of the mitral annulus were obtained. Isolated parameters of transmitral
flow correlated with M-LVDP only when ejection fraction <50%. The ratio of mitral
velocity to early diastolic velocity of the mitral annulus (E/E') showed a better
correlation with M-LVDP than did other Doppler variables for all levels of systolic
function. E/E' <8 accurately predicted normal M-LVDP, and E/E' >15 identified increased
M-LVDP. Wide variability was present in those with E/E' of 8 to 15. A subset of those
patients with E/E' 8 to 15 could be further defined by use of other Doppler data.
The combination of tissue Doppler imaging of the mitral annulus and mitral inflow
velocity curves provides better estimates of LV filling pressures than other methods
(pulmonary vein, preload reduction). However, accurate prediction of filling pressures
for an individual patient requires a stepwise approach incorporating all available
data.
[1
]From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn, and Division
of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Ariz (C.P.A.). Correspondence
to Steve R. Ommen, MD, 200 1st St SW, Rochester, MN 55905.