Validation of Six Noninvasive Doppler Methods for the Assessment of Left Ventricular Filling Pressure

OBJECTIVES: The aim of this study was to determine the accuracy of six noninvasive Doppler methods for assessing invasively derived left ventricular diastolic pressure (LVDP). BACKGROUND: To date, no studies have evaluated which of the various available Doppler methods are most reliable in determining LVDP in a consecutive patient population with different cardiac diseases. METHODS: LVDP was estimated by the following Doppler methods (M): (1) M1-the peak mitral regurgitant flow velocity (peak MR), (2) M2-the mitral regurgitant velocity at the time of aortic valve opening (MRAVO), (3) M3-the aortic regurgitant end-diastolic flow velocity (ARED), (4) M4-the ratio of the transmitral to mitral annular early diastolic velocity (ETM/EDTI), (5) M5-a transmitral flow velocity regression equation (RegrTM), and (6) M6-the difference of pulmonary venous and transmitral A wave duration (APV - ATM duration). For M1-M3, sphygmomanometric blood pressure was used to calculate LVDP. RESULTS: In 101 patients, the regression coefficient, standard error of estimate, and mean difference with confidence limits between Doppler and catheter-derived measurements were as follows: M1 (n = 46): r = 0.81 (P < 0.0001), 4.3 mmHg and 3.7 +/- 12.0 mmHg; M2 (n = 47): r = 0.79 (P < 0.0001), 5.4 mmHg and 1.1 +/- 11.2 mmHg; M3 (n = 20): r = 0.64 (P = 0.002), 7.8 mmHg and 4.6 +/- 17.6 mmHg; M4 (n = 50): r = 0.62 (P < 0.0001), 5.6 mmHg and 0 +/- 11.2 mmHg; M5 (n = 79): r = 0.24 (P = 0.03), 7.1 mmHg and - 0.1 +/- 16.8 mmHg; and M6 (n = 79): r = 0.22 (P = 0.05), 7.3 mmHg and 0 +/- 14.4 mmHg, respectively. CONCLUSIONS: The Doppler measurement of mitral regurgitant jets is most accurate method to estimate left ventricular filling pressure noninvasively.