Early diastolic driving force as a new Doppler index for prediction of left ventricular end diastolic pressure

We thought that the early diastolic driving force (DF) can offer a clinically reliable method to determine left ventricular end diastolic pressure (LVEDP). One hundred patients were scheduled for estimation of LVEDP by left-sided heart catheterization (LVEDPcath) and Echocardiography, via estimation of the mitral E wave velocity and its deceleration time (DT), to calculate the DF = density × volume × acceleration = 1.055 × (mitral valve area × velocity time integral) × peak E/acceleration time (AT) =1.055 × {(220/P1/2) × (E × AT)/2} × E/AT, if P1/2 = 0.29 DT, and hence DF = 400 E2/DT = 0.004 E2/DT Newton. Tissue Doppler estimation of the mitral annular E′ for the E/E′ ratio and septal (E/E′-S) and lateral (E/E′-L) was done. DF had a negative correlation (r = −0.63, P < 0.001), but E/E′-L and E/E′-S had positive correlations (r = 0.87 and 0.85 respectively, P < 0.001) with LVEDP. At a cutoff value of 0.1 N, DF had a sensitivity of 94.1%, specificity of 86.7%, to determine LVEDP > 16. E/E′-L is more sensitive and more specific than E/E′-S (72.9% and 93.3% vs. 58.8% and 86.7%) in prediction of LVEDPcath. DF is the almost powerful independent predictor of LVEDPcath (P = 0.002). DF had a coefficient = 0.619 (P < 0.001) for estimation of the LVEDP in the gray zone. Early diastolic DF could be used as a reliable index for elevated LVEDP, especially in the gray zone.