Assessment of left ventricular filling pressure using tissue doppler echocardiography
Abstract
Background: Assessment of left ventricular (LV) filling pressure is often necessary in clinical practice, especially in hemodinamically unstable patients. Echocardiography enables non-invasive assessment of many hemodinamical parameters and with the use of tissue Doppler echocardiography (TDE) also LV filling pressure. The ratio between mitral valve early diastolic velocity (E) and tissue Doppler mitral annular early diastolic velocity (Em) is in very good correlation with pulmonary artery wedge pressure. In our study we tried to evaluate the E/Em ratio in unselected population of patients with heart failure.
Methods: 50 patients with heart failure and 30 healthy individuals were included in the study. Standard echocardiographic exam and pulsed wave tissue Doppler was performed of septal border of mitral annulus were performed in all participants. The E/Em ratio was calculated and values compared between both groups. The correlation between E/Em ratio and age was assessed in healthy subjects.
Results: The E/Em ratio was significantly higher in patients with heart failure then in healthy subjects. The cut-off value 11 had 85 % sensitivity and 93 % specificity in diagnosing heart failure. There was no statistically significant correlation between E/Em ratio and age.
Conclusions: By using TDE and E/Em ratio, we can confirm the presence of elevated LV filling pressure in patients with heart failure.
Downloads
References
Nishimura RA, Abel MD, Hatle LK, et al. Relation of pulmonary vein to mitral flow velocities by transesophageal Doppler echocardiography: effect of different loading conditions. Circulation 1990; 81: 1488–97.
Nishimura R, Tajik A. Evaluation of diastolic filling of left ventricle in health and disease: Doppler echocardiography is the clinician’s Rosetta Stone. J Am Coll Cardiol 1997; 30: 8–18.
Tasič J, Ružič-Medvešček N. Tkivna doplerska ehokardiografija. Med Razgl 1999; 38 Suppl 6: 20–5.
Sohn DW, Chai IH, Lee DJ, Kim HC, Kim HS, Oh BH, et al. Assessment of mitral annulus velocity by Doppler tissue imaging in the evaluation of left ventricular diastolic function. J Am Coll Cardiol 1997; 30: 474–80.
Garcia MJ, Thomas JD, Klein AL. New Doppler echocardiographic applications for the study of diastolic function. J Am Coll Cardiol 1998; 32: 865–75.
Oki T, Tabata T, Yamada H, Wakatsuki T, Mishiro Y, Abe M, et al. Left ventricular diastolic properties of hypertensive patients measured by pulsed tissue Doppler imaging. J Am Soc Echocardiogr 1998; 11: 1106–12.
Tretjak M, Koželj M. Ocena funkcije levega prekata s tkivno doplersko ehokardiografijo. Zdrav Vestn 2004; 73: 663–7.
Sohn DW, Song JM, Zo JH, Chai IH, Kim HS, Chun HG, Kim HC. Mitral annulus velocity in the evaluation of left ventricular diastolic function in atrial fibrillation. J Am Soc Echocardiogr 1999; 12: 927–31.
Alam M, Wardell J, Andersson E, Nordlander R, Samad B. Assessment of left ventricular function using mitral annular velocities in patients with congestive heart failure with or without the presence of significant mitral regurgitation. J Am Soc Echocardiogr 2003; 16: 240–5.
Nagueh SF, Middleton KJ, Kopelen HA, Zoghbi WA, Quinones A. Doppler tissue imaging: a non-invasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. J Am Coll Cardiology 1997; 30: 1527–33.
Nagueh S, Mikari I, Kopelen H, Middleton K, Quinones M, Zoghbi W. Doppler estimation of left ventricular filling pressure in sinus tachycardia. A new application of tissue Doppler imaging. Circulation 1998; 98: 1644–50.
Ommen S, Nishimura R, Appleton C, Miller F, Oh J, Redfield M, Tajik A. Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures. Circulation 2000; 102: 1788–94.
Dokainish H, Zoghbi W, Lakkis N, Al-Bakshy F, Dhir M, Quinones M, Nagueh S. Optimal noninvasive assessment of left ventricular filling pressures: a comparison of tissue Doppler echocardiography and B-type natriuretic peptide in patients with pulmonary artery catheters. Circulation 2004; 109: 2432–9.
Oh JK. Echocardiography as a noninvasive Swan-Ganz Catheter. Circulation 2005; 111: 3192–4.
Cheitlin MD, Armstrong WF, Aurigemma GP, Beller GA, Bierman FZ, Davis JL, et al. ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography). 2003.
De Sutter J, De Backer J, Van de Veire N, Velghe A, De Buyzere M, Gillebert TC. Effects of age, gender, and left ventricular mass on septal mitral annulus velocity (E’) and the ratio of transmitral early peak velocity to E’ (E/E’). Am J Cardiol 2005; 95: 1020–3.
The Author transfers to the Publisher (Zdravniški vestnik/Slovenian Medical Journal) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Zdravniški vestnik/Slovenian Medical Journal) has the right to transfer the rights, acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.
