Clinical utility of Doppler echocardiography and tissue Doppler imaging inthe estimation of left ventricular filling pressures - A comparative simultaneous Doppler-Catheterization study

Background-Noninvasive assessment of diastolic filling by Doppler echocardi ography provides important information about left ventricular (LV) status i n selected subsets of patients. This study was designed to assess whether m itral annular velocities as assessed by tissue Doppler imaging are associat ed with invasive measures of diastolic LV performance and whether additiona l information is gained over traditional Doppler variables. Methods and Results-One hundred consecutive patients referred for cardiac c atheterization underwent simultaneous Doppler interrogation. Invasive measu rements of LV pressures were obtained with micromanometer-tipped catheters, and the mean LV diastolic pressure (M-LVDP) was used as a surrogate for me an left atrial pressure. Doppler signals from the mitral inflow, pulmonary venous inflow, and TDI of the mitral annulus were obtained. Isolated parame ters of transmitral flow correlated with M-LVDP only when ejection fraction <50%. The ratio of mitral velocity to early diastolic velocity of the mitr al annulus (E/E') showed a better correlation with M-LVDP than did other Do ppler variables for all levels of systolic function. E/E' <8 accurately pre dicted normal M-LVDP, and E/E' >15 identified increased M-LVDP. Wide variab ility 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. Conclusions-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.