Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures

Baylor College of Medicine and Department of Medicine, The Methodist Hospital, Houston, Texas 77030, USA. sherifn@bcm.tmc.edu

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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				G. Acharya, J. Rasanen, K. Makikallio, T. Erkinaro, T. Kavasmaa, M. Haapsamo, L. Mertens, and J. C. Huhta Metabolic acidosis decreases fetal myocardial isovolumic velocities in a chronic sheep model of increased placental vascular resistance Am J Physiol Heart Circ Physiol, January 1, 2008; 294(1): H498 - H504. [Abstract] [Full Text] [PDF]

				J. B. Geske, P. Sorajja, R. A. Nishimura, and S. R. Ommen Evaluation of Left Ventricular Filling Pressures by Doppler Echocardiography in Patients With Hypertrophic Cardiomyopathy: Correlation With Direct Left Atrial Pressure Measurement at Cardiac Catheterization Circulation, December 4, 2007; 116(23): 2702 - 2708. [Abstract] [Full Text] [PDF]

				T. Siegmund, P.-M. Schumm-Draeger, D. Antoni, and H. Von Bibra Beneficial effects of ramipril on myocardial diastolic function in patients with type 2 diabetes mellitus, normal LV systolic function and without coronary artery disease: a prospective study using tissue Doppler Diabetes and Vascular Disease Research, December 1, 2007; 4(4): 358 - 364. [Abstract] [PDF]

				I. Ikonomidis, J. T. Parissis, I. Paraskevaidis, K. Kourea, V. Bistola, J. Lekakis, G. Filippatos, and D. Th. Kremastinos Effects of levosimendan on coronary artery flow and cardiac performance in patients with advanced heart failure Eur J Heart Fail, December 1, 2007; 9(12): 1172 - 1177. [Abstract] [Full Text] [PDF]

				T. P. Abraham, V. L. Dimaano, and H.-Y. Liang Role of Tissue Doppler and Strain Echocardiography in Current Clinical Practice Circulation, November 27, 2007; 116(22): 2597 - 2609. [Full Text] [PDF]

				S. Huez, F. Roufosse, J-L. Vachiery, A. Pavelescu, G. Derumeaux, J-C. Wautrecht, E. Cogan, and R. Naeije Isolated right ventricular dysfunction in systemic sclerosis: latent pulmonary hypertension? Eur. Respir. J., November 1, 2007; 30(5): 928 - 936. [Abstract] [Full Text] [PDF]