Differences in Echocardiographic Assessment with Standard Doppler and Tissue Doppler Imaging of Left Ventricular Filling Pressure in Idiopathic and Ischemic Dilated Cardiomyopathy

Costanzo, Pierluigi; Prastaro, Maria; Perrino, Cinzia; Caiazzo, Gianluca; Monda, Cinzia; Guerra, Giuseppina; Iorio, Annamaria; Gargiulo, Paola; Chiariello, Massimo; Perrone‐Filardi, Pasquale

doi:10.1111/j.1540-8175.2008.00687.x

Cited by 2 publications

(1 citation statement)

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“…By echocardiography it is possible to estimate the LVFP noninvasively, analyzing the mitral inflow velocity and the pulmonary venous flow. [25][26][27] The echocardiographic estimation of LFVP can be influenced by MR. 28 Previous studies have reported on the estimation of mean PCWP by using mitral inflow in patients with MR. 29,30 Although several measurements derived from mitral inflow related well to PCWP, including IVRT, E/A, and DT, the best correlations between Doppler measurements and PCWP were observed in patients without significant MR. 29 Thus, the present study was undertaken to examine whether E/Ea was associated with invasive measures of LVEDP in patients with MR. 18 To overcome these limitations, combinations of the mitral flow velocity curves with TDI parameters have been proposed.…”

Section: Discussionmentioning

confidence: 99%

Noninvasive Assessment of Left Ventricular End-Diastolic Pressure with Tissue Doppler Imaging in Patients with Mitral Regurgitation

Yeşildağ

Köprülü²,

Yüksel

et al. 2011

Echocardiography

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Background: The ratio of early transmitral flow velocity to mitral annulus early diastolic velocity (E/Ea) is a widely used noninvasive tool to estimate left ventricular end diastolic pressure (LVEDP). The aim of this study was to explore whether E/Ea ratio was a reliable index for the estimation of LVEDP in patients with mitral regurgitation (MR). Methods: Sixteen patients with nonischemic MR (primary MR group; 6 male, 58 ± 12 years) 51 patients with ischemic MR (secondary MR group; 29 male, 63 ± 9 years) and 29 patients without MR (control group; 19 male, 53 ± 10 years) were consecutively included. The peak transmitral flow and mitral annular velocities during early diastole were measured. LVEDP was determined invasively by left heart catheterization. Results: Primary and secondary MR groups had significantly higher E/Ea ratios and LVEDP than control group. LVEDP significantly correlated with E/Ea ratio in patients with primary MR, but not in patients with secondary MR. Multiple regression analysis revealed that E/Ea ratio was an independent predictor of LVEDP in patients with primary MR. Ten patients with primary MR had LVEDP ≥15 mmHg. ROC analysis demonstrated cutoff values for E/Ea ratios as >10.5 for lateral mitral annulus (sensitivity: 80%, specificity: 66%, PPV: 80%, NPV: 66%) and as >14 for medial mitral annulus (sensitivity: 90%, specificity: 83%, PPV: 90%, NPV: 83%) to predict primary MR patients with LVEDP ≥15 mmHg. Conclusion: E/Ea ratio is still reliable in estimation of LVEDP in primary MR patients while it is not predictive for LVEDP in secondary MR patients. (Echocardiography 2011;28:633-640) Key words: echocardiography, left heart catheterization, left ventricular end-diastolic pressure, mitral regurgitation, tissue Doppler imaging Because of the large compliance of the pulmonary circulation, pulmonary capillary wedge pressure (PCWP) provides an indirect measure of the left atrial (LA) pressure (LAP) and left ventricular (LV) filling pressure (LVFP). PCWP is measured by inserting a balloon-tipped, multilumen catheter (Swan-Ganz catheter) into a peripheral vein, then advancing the catheter into the right atrium, right ventricle, pulmonary artery, and then into a branch of the pulmonary artery.

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