NONINVASIVE DOPPLER-ECHOCARDIOGRAPHIC EVALUATION OF LEFT-VENTRICULAR FILLING PRESSURES IN PATIENTS WITH CARDIOMYOPATHIES - A SIMULTANEOUS DOPPLER-ECHOCARDIOGRAPHIC AND CARDIAC-CATHETERIZATION STUDY

Objectives. The purpose of this study mas to examine the relation of t he mitral flow velocity curves to left ventricular filling pressures i n patients with two different types of myocardial problems: hypertroph ic cardiomyopathy and severe left ventricular systolic dysfunction. Ba ckground. Previous studies have suggested that assessment of Doppler-d erived mitral flow velocity curves can be used to predict left ventric ular filling pressures in specific disease entities. However, it is un clear whether information derived from specific mitral flow velocity c urves obtained from one disease entity can be valid in other disease s tates. Methods. The study group consisted of 42 patients with left ven tricular systolic dysfunction (group A) and 55 patients with hypertrop hic cardiomyopathy (group B); both groups underwent simultaneous cardi ac catheterization and were studied by Doppler echocardiography. High fidelity measures of left atrial and left ventricular pressures were o btained simultaneously with mitral flow velocity curves. Results. Ther e was a significant relation between the Doppler echocardiographic var iables and mean left atrial pressure in group A patients, The left atr ial pressure was directly related to the E/A ratio (r = 0.49, p = 0.00 1) and inversely related to the deceleration time (r = 0.73, p < 0.001 ), The sensitivity and specificity of the deceleration time, <180 m/s, which indicated a mean left atrial pressure greater than or equal to 20 mm Hg, were both 100%, In group B patients, there was Ilo significa nt relation between mean left atrial pressure and deceleration time. C onclusions. Doppler echocardiographic mitral flow velocity curves are useful in predicting anti estimating left ventricular filing pressures in patients with left ventricular dysfunction. However, because of th e complexity of the multiple interrelated factors that determine diast olic filling of the left ventricle, these flow velocity curves cannot be used in patients with other disease entities, such as hypertrophic cardiomyopathy. Future studies of different disease states are necessa ry to fully understand the role of Doppler echocardiography in the ass essment of diastolic filling.