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Determination of left ventricular filling pressure by new echocardiographic methods in patients with coronary artery disease

The International Journal of Cardiovascular Imaging volume 24, pages 141–147 (2008)Cite this article

Abstract

Aim

The present study was designed to determine the reliability of the analysis of the time difference between onset of mitral inflow and onset of early diastolic mitral annulus velocity and mean systolic strain index, and comparing them with E/E′ in the detection of increased left ventricular end-diastolic pressure (LVEDP) in patients with coronary artery disease.

Methods

Eighty patients (mean age: 57.2 ± 11.5 years) referred for cardiac catheterization were studied. Patients were divided into 2 groups according to LVEDP (group 1: LVEDP > 20 mmHg, n = 39 patients; group 2: LVEDP ≤20 mmHg, n = 41 patients). From the mitral inflow, peak E velocity was calculated. With tissue Doppler echocardiography, early diastolic velocity (E′) measured from the septal, lateral, inferior and lateral mitral annulus and mean value of E′ and E/E′ ratio were calculated. The time difference between onset of mitral inflow and onset of early diastolic mitral annulus velocity (TE′-E) was calculated. From the apical chambers, the peak systolic strain value of 16 left ventricular (LV) segments was measured and the mean of these 16 segments was calculated and referred to as mean systolic strain index.

Results

The patients with increased LVEDP (group 1) had a higher E/E′ ratio (13.8 ± 3.4 vs. 9.9 ± 2.8, P < 0.001) and lower mean systolic strain index (11.8 ± 3.4 % vs. 13.5 ± 3.6 %, P = 0.038) than patients in group 2. The sensitivity of E/E′ > 13.42 for identifying LVEDP > 20 mmHg was 71%, with a specificity of 89%. The sensitivity of a mean systolic strain index < 10.57% for identifying LVEDP > 20 mmHg was 44%, with a specificity of 83%. TE′-E was not significantly different between the two groups.

Conclusion

The decreased longitudinal function of the left ventricle is related to increased LVEDP. The E/E’ ratio, which in recent years has been used for the prediction of LV filling pressures, was a better predictor for increased LVEDP than the mean systolic strain score index and the time difference between onset of mitral inflow and onset of early diastolic mitral annulus velocity in patients with coronary artery disease.

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References

  1. Appleton CP, Hale LK, Popp RL (1988) Relation of transmitral flow velocity patterns to left ventricular diastolic function: new insights from a combined hemodynamic and Doppler echocardiographic study. J Am Coll Cardiol 12:426–440

    PubMed  CAS  Article  Google Scholar 

  2. Rossvoll O, Hatle LK (1993) Pulmonary venous flow velocities recorded by transthoracic Doppler ultrasound: relation to left ventricular diastolic pressures. J Am Coll Cardiol 21:426–440

    Article  Google Scholar 

  3. Choong CY, Abascal VM, Thomas JD, Guerrero JL, McGlew S, Weyman AE (1988) Combined influence of ventricular loading and relaxation on the transmitral flow velocity profile in dogs measured by Doppler echocardiography. Circulation 78:672–683

    PubMed  CAS  Google Scholar 

  4. Nagueh SF, Midleton 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 30:1527–1533

    PubMed  Article  CAS  Google Scholar 

  5. Ommen SR, Nishimura RA, Appleton CP et al (2000) Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressure: a comparative simultaneous Doppler-catheterization study. Circulation 102:788–794

    Google Scholar 

  6. Gotz RC, Khoury DS, Manolios M, Rao LKopelen HA, Nagueh SF (2003) Time interval between onset of mitral inflow and onset of early diastolic velocity by tissue Doppler: a novel index of left ventricular pressure. J Am Coll Cardiol 42:1463–1470

    Article  Google Scholar 

  7. Sohn DW, Kim YJ, Park YB, Choi YS (2004) Clinical validity of measuring time difference between onset of mitral inflow and onset of early diastolic mitral annulus velocity in the evaluation of left ventricular diastolic function. J Am Coll Cardiol 43:2097–2101

    PubMed  Article  Google Scholar 

  8. Yamamoto K, Nishimura RA, Chaliki HP, Appleton CP, Holmes DR, Redfield MM (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 30:1819–1826

    PubMed  Article  CAS  Google Scholar 

  9. Gotz CR, Manolios M, Thohan V, Nagueh SF (2003) Impact of left ventricular ejection fraction on estimation of left ventricular filling pressure using tissue Doppler and flow propagation velocity. Am J Cardiol 91:780–784

    Article  Google Scholar 

  10. Garcia MJ, Ares MA, Asher C, Rodriguez L, Vandervoort P, Thomas JD (1997) Color M-mode flow velocity propagation: an index of early left ventricular filling that combined with pulse Doppler peak E velocity may predict capillary wedge pressure. J Am Coll Cardiol 29:448–454

    PubMed  Article  CAS  Google Scholar 

  11. Kidawa M, Coignard L, Drobinski B et al (2005) Comparative value of tissue Doppler imaging and m-mode color Doppler mitral flow propagation velocity for the evaluation of left ventricular filling pressure. Chest 128:2544–2550

    PubMed  Article  Google Scholar 

  12. Arques S, Roux E, Luccioni R (2007) Current clinical applications of spectral tissue Doppler echocardiography (E/E′ ratio) as a noninvasive surrogate for left ventricular diastolic pressures in the diagnosis of heart failure with preserved left ventricular systolic function. Cardiovasc Ultrasound 5:16

    PubMed  Article  Google Scholar 

  13. Sutherland GR, Di Salvo G, Claus P, D’hooge J, Bijnens B (2004) Strain and strain rate imaging: a new clinical approach to quantifying regional myocardial function. J Am Soc of Echocardiog 17(7):788–802

    Article  Google Scholar 

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Affiliations

  1. Cardiology Department, Hacettepe University, Ankara, Turkey

    Necla Özer, Alper Kepez, Barış Kaya, Ali Deniz, Enver Atalar, Kenan Övünç & Serdar Aksöyek

  2. Biostatistics Department, Hacettepe University, Ankara, Turkey

    Umut Arslan

  3. Internal Medicine Department, Ankara Dışkapı Yıldırım Beyazıt Hospital, Ankara, Turkey

    Harun Kılıç

  4. Bascavus Sok. Hatipoglu Apt. 76/8, Kucukesat, Ankara, Turkey

    Alper Kepez

Authors
  1. Necla Özer
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  2. Alper Kepez
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  3. Barış Kaya
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  4. Harun Kılıç
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  5. Ali Deniz
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  6. Umut Arslan
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  7. Enver Atalar
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  8. Kenan Övünç
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  9. Serdar Aksöyek
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Correspondence to Alper Kepez.

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Özer, N., Kepez, A., Kaya, B. et al. Determination of left ventricular filling pressure by new echocardiographic methods in patients with coronary artery disease. Int J Cardiovasc Imaging 24, 141–147 (2008). https://doi.org/10.1007/s10554-007-9238-4

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  • DOI: https://doi.org/10.1007/s10554-007-9238-4

Keywords

  • Coronary artery disease
  • Left ventricular end-diastolic pressure
  • Tissue doppler
  • Echocardiographic strain analysis