CORRELATION OF TISSUE DOPPLER VARIABLES WITH LEFT VENTRICULAR FILLING PRESSURES

Diastolic dysfunction is common in cardiac disease and contributes to the signs and symptoms of heart failure. The assessment of diastolic filling by Doppler echocardiography gives important information about left ventricular (LV) status only in selected subset of patients. evaluation of reliability of tissue Doppler imaging indexes in prediction of high LV filling pressures. 105 patients were included in the study. They were divided in groups according to left ventricular end-diastolic pressure (LVEDP) and left ventricular ejection fraction (LVEF). LVEDP was obtained before coronary angiography and ventriculography. An elevated LV filling pressure was defined as LVEDP ? 16 mmHg. 42 patients had elevated LV filling pressures. During echocardiographic examination the LVEF, Doppler velocities of early (E) and late (A) diastolic flow, the deceleration time (DTE), peak systolic (S’) and peak early (E’) and late (A’) diastolic mitral annular velocities were obtained. E/E’ and E’/A’ ratios and E’/(A’xS’) and E/(E’xS’) indexes were then calculated. The parameters of transmitral flow correlates with LVEDP only when EF was reduced. The ratio of E/E’ shows a better correlation with LVEDP for all levels of systolic function. For predicting high LVEDP an E/E’ ratio >7.7 provides a sensitivity and specificity of 70%. Deceleration time of E wave, E/E’ ratio and E/(E’xS’) index were more accurate than E’/A’ ratio and E’/(A’xS’) index in predicting high LVEDP. The E/E’ ratio is the best predictor of LV filling pressure for all levels of systolic function, but it can’t be used in isolation for the assessment of left ventricular diastolic dysfunction.