Clinical Research in Cardiology

, Volume 102, Issue 8, pp 563–570 | Cite as

The pulsed Doppler and tissue Doppler-derived septal E/e′ ratio is significantly related to invasive measurement of ventricular end-diastolic pressure in biventricular rather than univentricular physiology in patients with congenital heart disease

  • Y. P. Mi
  • H. Abdul-KhaliqEmail author
Original Paper



The value of conventional non-invasive Doppler parameters to predict ventricular end-diastolic pressure (EDP) and diastolic function in congenital heart diseases is limited. The aim of our prospective study was to investigate whether the ratio of mitral early blood inflow velocity to early diastolic velocity of the mitral annulus (E/e′) as assessed by pulsed tissue Doppler is related to EDP in patients with different congenital heart disease (CHD) undergoing left heart catheterization.


A total of 115 hospital inpatients (64 male) with different CHD referred for cardiac catheterization were simultaneously examined by echocardiography for non-invasive estimation of ventricular EDP during heart catheterization. The mean age at catheterization was 8.71 years (range 3 days to 18 years). These patients were divided into two groups according to the different hemodynamic and morphology conditions: group A consisted of patients with biventricular heart and group B of patients with univentricular heart.


For all the studied patients, a significant positive correlation was found between E/e′ and EDP (r = 0.54, P < 0.001). EDP correlated rather weakly with combined measurements E/global LV early diastolic velocity (r = 0.27, P = 0.02). A significant relationship was also found between ventricular EDP and early mitral inflow velocity E (r = 0.36, P = 0.001). The ratio of pulmonary venous flow velocities s/d was not found to be related to invasively measured EDP (r = −0.16, P = 0.13). Group A (n = 96) had similar results, but for group B (n = 19), these parameters did not show a relationship to EDP. The analysis of these parameters showed that the larger area under the curve (AUC) was found for the ratio of E/e′ (AUC = 0.77) compared with E/global e′ (AUC = 0.57). E/e′ > 10.7 had 69 % sensitivity and 81 % specificity for EDP > 10 mmHg.


Doppler and tissue Doppler-derived E/e′ ratio is related to simultaneous invasive measurement of EDP in a heterogeneous group of patients with CHD and may provide an additional surrogate non-invasive estimation of ventricular diastolic performance in the routine follow-up of these patients.


End-diastolic pressure Septal E/e′ Congenital heart disease 



Ms. Yaping Mi is research fellow of the Deutsche Akademischer Austauch Dienst (DAAD), Bonn. This work was supported by the Kompetenznetz Angeborene Herzfehler (Competence Network for Congenital Heart Defects) funded by the Federal Ministry of Education and Research (BMBF), FKZ 01G10210. We thank Anne M. Gale for editorial assistance.


  1. 1.
    Nishimura RA, Tajik AJ (1997) Evaluation of diastolic filling of left ventricle in health and disease: Doppler echocardiography is the clinician’s Rosetta stone. J Am Coll Cardiol 30:8–18PubMedCrossRefGoogle Scholar
  2. 2.
    Brunazzi MC, Chirillo F, Pasqualini M et al (1994) Estimation of left ventricular diastolic pressures from precordial pulsed-Doppler analysis of pulmonary venous and mitral flow. Am Heart J 128:293–300PubMedCrossRefGoogle Scholar
  3. 3.
    Yamamoto K, Nishimura RA, Burnett JC Jr et al (1997) Assessment of left ventricular end-diastolic pressure by Doppler echocardiography: contribution of duration of pulmonary venous versus mitral flow velocity curves at atrial contraction. J Am Soc Echocardiogr 10:52–59PubMedCrossRefGoogle Scholar
  4. 4.
    Steen T, Rootwelt K, Risoe C et al (1995) A new color M-mode index of diastolic filling compared with radionuclide ventriculography. Int J Cardiol 48:89–95PubMedCrossRefGoogle Scholar
  5. 5.
    Hurrell DG, Nishimura RA, Ilstrup DM et al (1997) Utility of preload alteration in assessment of left ventricular filling pressure by Doppler echocardiography: a simultaneous catheterization and Doppler echocardiographic study. J Am Coll Cardiol 30:459–467PubMedCrossRefGoogle Scholar
  6. 6.
    Ommen SR, Nishimura RA, Appleton CP, Miller FA, Oh JK, Redfield MM, Tajik AJ (2000) Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: a comparative simultaneous Doppler-catheterization study. Circulation 102(15):1788–1794PubMedCrossRefGoogle Scholar
  7. 7.
    Nagueh SF, Sun H, Kopelen HA, Middleton KJ, Khoury DS (2001) Hemodynamic determinants of the mitral annulus diastolic velocities by tissue Doppler. J Am Coll Cardiol 37(1):278–285PubMedCrossRefGoogle Scholar
  8. 8.
    Dokainish H, Sengupta R, Pillai M, Bobek J, Lakkis N (2008) Usefulness of new diastolic strain and strain rate indexes for the estimation of left ventricular filling pressure. Am J Cardiol 101(10):1504–1509PubMedCrossRefGoogle Scholar
  9. 9.
    Moller JE, Sondergaard E, Poulsen SH et al (2001) Color M-mode and pulsed wave tissue Doppler echocardiography: powerful predictors of cardiac events after first myocardial infarction. J Am Soc Echocardiogr 14:757–763PubMedCrossRefGoogle Scholar
  10. 10.
    Wang M, Yip GW, Wang AY et al (2003) Peak early diastolic mitral annulus velocity by tissue Doppler imaging adds independent and incremental prognostic value. J Am Coll Cardiol 41:820–826PubMedCrossRefGoogle Scholar
  11. 11.
    Paraskevaidis IA, Panou F, Papadopoulos C, Farmakis D, Parissis J, Ikonomidis I, Rigopoulos A, Iliodromitis EK, Th Kremastinos D (2009) Evaluation of left atrial longitudinal function in patients with hypertrophic cardiomyopathy: a tissue Doppler imaging and two-dimensional strain study. Heart 95(6):483–489PubMedCrossRefGoogle Scholar
  12. 12.
    Cho GY, Marwick TH, Kim HS, Kim MK, Hong KS, Oh DJ (2009) Global 2-dimensional strain as a new prognosticator in patients with heart failure. J Am Coll Cardiol 54(7):618–624PubMedCrossRefGoogle Scholar
  13. 13.
    Sun JP, Stewart WJ, Yang XS, Donnell RO, Leon AR, Felner JM, Thomas JD, Merlino JD (2009) Differentiation of hypertrophic cardiomyopathy and cardiac amyloidosis from other causes of ventricular wall thickening by two-dimensional strain imaging echocardiography. Am J Cardiol 103(3):411–415PubMedCrossRefGoogle Scholar
  14. 14.
    Dokainish H, Sengupta R, Pillai M, Bobek J, Lakkis N (2008) Assessment of left ventricular systolic function using echocardiography in patients with preserved ejection fraction and elevated diastolic pressures. Am J Cardiol 101(12):1766–1771PubMedCrossRefGoogle Scholar
  15. 15.
    Choong CY, Herrmann HC, Weyman AE et al (1987) Preload dependence of Doppler-derived indexes of left ventricular diastolic function in humans. J Am Coll Cardiol 10:800–808PubMedCrossRefGoogle Scholar
  16. 16.
    Eriksson SV, Bjorkander I, Held C et al (1996) Age and gender differences in left ventricular function among patients with stable angina and a matched control group: a report from the Angina Prognosis Study in Stockholm. Cardiology 87:287–293PubMedCrossRefGoogle Scholar
  17. 17.
    Rihal CS, Nishimura RA, Hatle LK et al (1994) Systolic and diastolic dysfunction in patients with clinical diagnosis of dilated cardiomyopathy: relation to symptoms and prognosis. Circulation 90:2772–2779PubMedCrossRefGoogle Scholar
  18. 18.
    Temporelli PL, Corra U, Imparato A et al (1998) Reversible restrictive left ventricular diastolic filling with optimized oral therapy predicts a more favorable prognosis in patients with chronic heart failure. J Am Coll Cardiol 31:1591–1597PubMedCrossRefGoogle Scholar
  19. 19.
    Yamamoto K, Nishimura RA, Chaliki HP et al (1997) Determination of left ventricular filling pressure by Doppler echocardiography in patients with coronary artery disease: critical role of left ventricular systolic function. J Am Coll Cardiol 30:1819–1826PubMedCrossRefGoogle Scholar
  20. 20.
    Oh JK, Appleton CP, Hatle LK et al (1997) The noninvasive assessment of left ventricular diastolic function with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 10:246–270PubMedCrossRefGoogle Scholar
  21. 21.
    Nishimura RA, Appleton CP, Redfield MM et al (1996) Noninvasive Doppler echocardiographic evaluation of left ventricular filling pressures in patients with cardiomyopathies: a simultaneous Doppler echocardiographic and cardiac catheterization study. J Am Coll Cardiol 28:1226–1233PubMedCrossRefGoogle Scholar
  22. 22.
    Nishimura RA, Appleton CP, Redfield MM, Ilstrup DM, Holmes DR Jr, Tajik AJ (1996) Noninvasive Doppler echocardiographic evaluation of left ventricular filling pressures in patients with cardiomyopathies: a simultaneous Doppler echocardiographic and cardiac catheterization study. J Am Coll Cardiol 28:1226–1233PubMedCrossRefGoogle Scholar
  23. 23.
    Voigt JU, Arnold MF, Karlsson M et al (2000) Assessment of regional longitudinal myocardial strain rate derived from Doppler myocardial imaging indexes in normal and infarcted myocardium. J Am Soc Echocardiogr 13:588–598PubMedCrossRefGoogle Scholar
  24. 24.
    Aranda JM Jr, Weston MW, Puleo JA et al (1998) Effect of loading conditions on myocardial relaxation velocities determined by Doppler tissue imaging in heart transplant recipients. J Heart Lung Transplant 17:693–697PubMedGoogle Scholar
  25. 25.
    Sohn DW, Chai IH, Lee DJ et al (1997) Assessment of mitral annulus velocity by Doppler tissue imaging in the evaluation of left ventricular diastolic function. J Am Coll Cardiol 30:474–480PubMedCrossRefGoogle Scholar
  26. 26.
    Gulati VK, Katz WE, Follansbee WP et al (1996) Mitral annular descent velocity by tissue Doppler echocardiography as an index of global left ventricular function. Am J Cardiol 77:979–984PubMedCrossRefGoogle Scholar
  27. 27.
    Nagueh SF, Middleton KJ, Kopelen HA, Zoghbi WA, Quinones MA (1997) Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. J Am Coll Cardiol 30:1527–1533PubMedCrossRefGoogle Scholar
  28. 28.
    Nagueh SF, Mikati I, Kopelen HA et al (1998) Doppler estimation of left ventricular filling pressure in sinus tachycardia: a new application of tissue Doppler imaging. Circulation 98:1644–1650PubMedCrossRefGoogle Scholar
  29. 29.
    Nagueh SF, Lakkis NM, Middleton KJ et al (1999) Doppler estimation of left ventricular filling pressures in patients with hypertrophic cardiomyopathy. Circulation 99:254–261PubMedCrossRefGoogle Scholar
  30. 30.
    Hirata K et al (2009) Usefulness of a combination of systolic function by left ventricular ejection fraction and diastolic function by E/E/E’ to predict prognosis in patients with heart failure. Am J Cardiol 103:1275–1279PubMedCrossRefGoogle Scholar
  31. 31.
    Hillis GS, Moller JE, Pellikka PA, Gersh BJ, Wright RS, Ommen SR, Reeder GS, Oh JK (2004) Noninvasive estimation of left ventricular filling pressure by E/E’ is a powerful predictor of survival after acute myocardial infarction. J Am Coll Cardiol 43:360–367PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Department of Pediatric CardiologySaarland University HospitalHomburgGermany

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