Key result
Mitral E/Ea ratio strongly correlates with invasive PCWP to noninvasively estimate LV filling pressures.
Why the study?
Recent observations suggested mitral annular Ea reflects LV relaxation less influenced by filling pressures, prompting investigation into whether Ea is preload-independent and whether E/Ea relates to LV filling pressures.
Does the E/Ea ratio derived from Doppler tissue imaging accurately estimate left ventricular filling pressures?
Cross-Sectional (n=125)
Does the E/Ea ratio derived from Doppler tissue imaging accurately estimate left ventricular filling pressures?
Effect estimate: r = 0.87
The E/Ea ratio derived from Doppler tissue imaging is a reliable, noninvasive index for estimating left ventricular filling pressures.
May aid noninvasive LV filling pressure estimation; leaves open prospective validation before routine adoption.
OBJECTIVES: This investigation was designed 1) to assess whether the early diastolic velocity of the mitral annulus (Ea) obtained with Doppler tissue imaging (DTI) behaves as a preload-independent index of left ventricular (LV) relaxation; and 2) to evaluate the relation of the mitral E/Ea ratio to LV filling pressures. BACKGROUND: Recent observations suggest that Ea is an index of LV relaxation that is less influenced by LV filling pressures. METHODS: One hundred twenty-five study subjects were classified into three groups according to mitral E/A ratio, LV ejection fraction (LVEF) and clinical symptoms: 34 asymptomatic subjects with a normal LVEF and an E/A ratio > or =1; 40 with a normal LVEF, an E/A ratio <1 and no heart failure symptoms (impaired relaxation [IR]); and 51 with heart failure symptoms and an E/A ratio >1 (pseudonormal [PN]). Ea was derived from the lateral border of the annulus. A subset of 60 patients had invasive measurement of pulmonary capillary wedge pressure (PCWP) simultaneous with Doppler echocardiographic DTI. RESULTS: Ea was reduced in the IR and PN groups compared with the group of normal subjects: 5.8 +/- 1.5 and 5.2 +/- 1.4 vs. 12 +/- 2.8 cm/s, respectively (p < 0.001). Mean PCWP (20 +/- 8 mm Hg) related weakly to mitral E (r = 0.68) but not to Ea. The E/Ea ratio related well to PCWP (r = 0.87; PCWP = 1.24 [E/Ea] + 1.9), with a difference between Doppler and catheter measurements of 0.1 +/- 3.8 mm Hg. CONCLUSIONS: Ea behaves as a preload-independent index of LV relaxation. Mitral E velocity, corrected for the influence of relaxation (i.e., the E/Ea ratio), relates well to mean PCWP and may be used to estimate LV filling pressures.
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Nagueh et al. (1997) conducted a cross-sectional in Left ventricular diastolic dysfunction (n=125). Doppler tissue imaging (E/Ea ratio) vs. Invasive pulmonary capillary wedge pressure (PCWP) was evaluated on Correlation between E/Ea ratio and PCWP (r = 0.87). The mitral E/Ea ratio derived from Doppler tissue imaging correlated strongly with invasive pulmonary capillary wedge pressure (r = 0.87), allowing noninvasive estimation of LV filling pressures.
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