Utility of preload alteration in assessment of left ventricular filling pressure by Doppler echocardiography: a simultaneous catheterization and Doppler echocardiographic study

Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.

OBJECTIVES: The aim of this study was to demonstrate the usefulness of preload alterations in assessing left ventricular filling pressures with transmitral Doppler velocity curves. BACKGROUND: Doppler mitral inflow velocities, used to estimate left ventricular filling pressures noninvasively, are limited in predicting left ventricular filling pressures, especially in patients with normal systolic function and a "pseudonormal" mitral filling pattern. METHODS: Forty-nine patients were studied in the cardiac catheterization laboratory with simultaneous Doppler echocardiography using high fidelity catheters to compare left ventricular diastolic filling pressures (pre-A wave left ventricular pressure) and Doppler mitral inflow at baseline and during reduction of preload during the strain phase of the Valsalva maneuver (n = 27) or sublingual nitroglycerin (n = 36), or both (n = 14). Doppler measurements consisted of E (initial peak velocity), A (velocity at atrial contraction), deceleration time (time from E velocity to deceleration of flow extrapolated to baseline) and absolute A wave velocity (A' [peak A wave velocity minus velocity at onset of atrial contraction]). RESULTS: In patients with high pre-A wave pressure (> or 15 mm Hg), there was a greater change in the E/A' ratio during the Valsalva maneuver than in patients with a normal pre-A wave pressure (-1.22 +/- 1.1 vs. -0.35 +/- 0.17; p = 0.02). A similar change was seen when comparing the change in the E/A' ratio after administration of nitroglycerin in patients with a high versus a normal pre-A wave pressure (0.81 +/- 0.49 vs. 0.18 +/- 0.17; p < 0.001). These differences were present in patients with a normal E/A ratio at baseline. CONCLUSIONS: Alterations in preload during assessment of Doppler echocardiographic indexes may be useful in noninvasively assessing left ventricular filling pressures.

This article has been cited by other articles:

				A. Rossi, M. Cicoira, S. Bonapace, G. Golia, L. Zanolla, L. Franceschini, and C. Vassanelli Left atrial volume provides independent and incremental information compared with exercise tolerance parameters in patients with heart failure and left ventricular systolic dysfunction Heart, November 1, 2007; 93(11): 1420 - 1425. [Abstract] [Full Text] [PDF]

				J. E. Moller, P. A. Pellikka, G. S. Hillis, and J. K. Oh Prognostic Importance of Diastolic Function and Filling Pressure in Patients With Acute Myocardial Infarction Circulation, August 1, 2006; 114(5): 438 - 444. [Full Text] [PDF]

				L. Shmuylovich and S. J. Kovacs Load-independent index of diastolic filling: model-based derivation with in vivo validation in control and diastolic dysfunction subjects J Appl Physiol, July 1, 2006; 101(1): 92 - 101. [Abstract] [Full Text] [PDF]

				M. Kidawa, L. Coignard, G. Drobinski, M. Krzeminska-Pakula, D. Thomas, M. Komajda, and R. Isnard Comparative Value of Tissue Doppler Imaging and M-Mode Color Doppler Mitral Flow Propagation Velocity for the Evaluation of Left Ventricular Filling Pressure Chest, October 1, 2005; 128(4): 2544 - 2550. [Abstract] [Full Text] [PDF]

				B. P. Paelinck, A. de Roos, J. J. Bax, J. M. Bosmans, R. J. van Der Geest, D. Dhondt, P. M. Parizel, C. J. Vrints, and H. J. Lamb Feasibility of tissue magnetic resonance imaging: A pilot study in comparison with tissue Doppler imaging and invasive measurement J. Am. Coll. Cardiol., April 5, 2005; 45(7): 1109 - 1116. [Abstract] [Full Text] [PDF]

				P. M. Srivastava, L. M. Burrell, and P. Calafiore Lateral vs medial mitral annular tissue Doppler in the echocardiographic assessment of diastolic function and filling pressures: which should we use? Eur J Echocardiogr, March 1, 2005; 6(2): 97 - 106. [Abstract] [Full Text] [PDF]

				A Rossi, M Cicoira, G Golia, L Zanolla, L Franceschini, P Marino, M Graziani, and P Zardini Amino-terminal propeptide of type III procollagen is associated with restrictive mitral filling pattern in patients with dilated cardiomyopathy: a possible link between diastolic dysfunction and prognosis Heart, June 1, 2004; 90(6): 650 - 654. [Abstract] [Full Text] [PDF]

				G. S. Hillis, J. E. Moller, P. A. Pellikka, B. J. Gersh, R. S. Wright, S. R. Ommen, G. S. Reeder, and J. K. Oh Noninvasive estimation of left ventricular filling pressure by e/e' is a powerful predictor of survival after acute myocardial infarction J. Am. Coll. Cardiol., February 4, 2004; 43(3): 360 - 367. [Abstract] [Full Text] [PDF]

				B. Phillip, D. Pastor, W. Bellows, and J. M. Leung The Prevalence of Preoperative Diastolic Filling Abnormalities in Geriatric Surgical Patients Anesth. Analg., November 1, 2003; 97(5): 1214 - 1221. [Abstract] [Full Text] [PDF]

				S R Ommen and R A Nishimura A clinical approach to the assessment of left ventricular diastolic function by Doppler echocardiography: update 2003 Heart, November 1, 2003; 89(90003): iii18 - 23. [Full Text] [PDF]

				B.P Paelinck, J.W.M van Eck, S.G De Hert, and T.C Gillebert Effects of postural changes on cardiac function in healthy subjects Eur J Echocardiogr, September 1, 2003; 4(3): 196 - 201. [Abstract] [Full Text] [PDF]

				J. E. Moller, G. S. Hillis, J. K. Oh, J. B. Seward, G. S. Reeder, R. S. Wright, S. W. Park, K. R. Bailey, and P. A. Pellikka Left Atrial Volume: A Powerful Predictor of Survival After Acute Myocardial Infarction Circulation, May 6, 2003; 107(17): 2207 - 2212. [Abstract] [Full Text] [PDF]

				M. M. Redfield, S. J. Jacobsen, J. C. Burnett Jr, D. W. Mahoney, K. R. Bailey, and R. J. Rodeheffer Burden of Systolic and Diastolic Ventricular Dysfunction in the Community: Appreciating the Scope of the Heart Failure Epidemic JAMA, January 8, 2003; 289(2): 194 - 202. [Abstract] [Full Text] [PDF]

				A. Rossi, M. Cicoira, L. Zanolla, R. Sandrini, G. Golia, P. Zardini, and M. Enriquez-Sarano Determinants and prognostic value of left atrial volume in patients with dilated cardiomyopathy J. Am. Coll. Cardiol., October 16, 2002; 40(8): 1425 - 1430. [Abstract] [Full Text] [PDF]

				P. Ambrosi, C. Oddoze, and G. Habib Utility of B-Natriuretic Peptide in Detecting Diastolic Dysfunction: Comparison With Doppler Velocity Recordings Circulation, October 8, 2002; 106 (15): e70 - e70. [Full Text] [PDF]

				M. M. Redfield, R. J. Rodeheffer, S. J. Jacobsen, D. W. Mahoney, K. R. Bailey, and J. C. Burnett Jr Plasma brain natriuretic peptide concentration: impact of age and gender J. Am. Coll. Cardiol., September 4, 2002; 40(5): 976 - 982. [Abstract] [Full Text] [PDF]

				G. N. Djaiani, B. J. McCreath, L. K. Ti, B. G. Mackensen, M. Podgoreanu, B. Phillips-Bute, and J. P. Mathew Mitral Flow Propagation Velocity Identifies Patients with Abnormal Diastolic Function During Coronary Artery Bypass Graft Surgery Anesth. Analg., September 1, 2002; 95(3): 524 - 530. [Abstract] [Full Text] [PDF]

				G. A. Whalley, W. Bagg, R. N. Doughty, G. Gamble, G. Braatvedt, and N. Sharpe Pseudonormal Diastolic Filling Unmasked With Glyceryl Trinitrate in Patients With Type 2 Diabetes With Poor Metabolic Control Diabetes Care, July 1, 2001; 24(7): 1307 - 1308. [Full Text] [PDF]

				S. R. Ommen, R. A. Nishimura, C. P. Appleton, F. A. Miller, J. K. Oh, M. M. Redfield, and A. J. Tajik Clinical Utility of Doppler Echocardiography and Tissue Doppler Imaging in the Estimation of Left Ventricular Filling Pressures : A Comparative Simultaneous Doppler-Catheterization Study Circulation, October 10, 2000; 102(15): 1788 - 1794. [Abstract] [Full Text] [PDF]

				K. Mizushige, L. Yao, T. Noma, H. Kiyomoto, Y. Yu, N. Hosomi, K. Ohmori, and H. Matsuo Alteration in Left Ventricular Diastolic Filling and Accumulation of Myocardial Collagen at Insulin-Resistant Prediabetic Stage of a Type II Diabetic Rat Model Circulation, February 29, 2000; 101(8): 899 - 907. [Abstract] [Full Text] [PDF]

				J. Muller, G. Wallukat, M. Dandel, H. Bieda, K. Brandes, S. Spiegelsberger, E. Nissen, R. Kunze, and R. Hetzer Immunoglobulin Adsorption in Patients With Idiopathic Dilated Cardiomyopathy Circulation, February 1, 2000; 101(4): 385 - 391. [Abstract] [Full Text] [PDF]