Doppler estimation of left ventricular filling pressures in patients with hypertrophic cardiomyopathy

Background-Conventional Doppler parameters are unreliable for estimating le ft ventricular (LV) filling pressures in hypertrophic cardiomyopathy (HCM). This study was undertaken to evaluate flow propagation velocity by color M -mode and early diastolic annular velocity (Ea) by tissue Doppler 2 new ind ices of LV relaxation, combined with mitral E velocity for estimation of fi lling pressures in HCM. Methods and Results-Thirty-five HCM patients (52 +/- 15 years) underwent LV catheterization simultaneously with 2-dimensional and Doppler echocardiogr aphy. Pulsed Doppler echocardiography of mitral and pulmonary venous flows was obtained along with flow propagation velocity and Ea. LV preA pressure had weak or no relations with mitral, pulmonary venous velocities and atria l volumes. In contrast, preA pressure related strongly to E velocity/flow p ropagation velocity (r=0.67; SEE=4) and E/Ea (r=0.76; SEE=3.4). In 17 patie nts with repeat measurements, preA pressure changes were well detected by m easuring E velocity/flow propagation velocity (r=0.68; P=0.01) or E/Ea (r=0 .8; P<0.001). PreA pressure estimation with these 2 methods was tested pros pectively in 17 additional HCM patients with good results (E velocity/flow propagation velocity, r=0.76; E/Ea, r=0.82). Conclusions-LV filling pressures can be estimated with reasonable accuracy in HCM patients by measuring E velocity/flow propagation velocity or E/Ea. These ratios also track changes in filling pressures.