The Validity of Pulse Wave Tissue Doppler Imaging in Predicting Elevated left Ventricular end Diastolic Pressure in Patients with Coronary Artery Disease
Iraqi Postgraduate Medical Journal,
2016, Volume 15, Issue 3, Pages 296-302
Elevated left ventricular filling pressures are the main physiological consequence of diastolic dysfunction and carry a prognostic significance in different cardiovascular diseases including coronary artery diseases, and cardiomyopathies. Filling pressures are considered elevated when the mean pulmonary capillary wedge pressure is >12mmHg or when the left ventricular end diastolic pressure is ≥ 16 mm Hg. a reliable noninvasive method for the estimation of LVEDP is needed.
The aim of this study was to evaluate the correlation between the Tissue Doppler Imaging derived E/é ratio, and Left Ventricular End Diastolic Pressure (measured during left ventricular catheterization) in patients with significant Coronary artery Disease, and to identify the optimal cutoff value of the E/é ratio to predict elevated LVEDP.
PATIENTS AND METHODS:
This study included 87 patients scheduled for elective coronary angiography at Ibn-Albitar Hospital catheterization laboratory between December 2012 and April 2013.Transthoracic echocardiography was performed to all patients within 2 hours before left heart catheterization, using Philips echocardiography system & S5-1 probe. Mitral valve inflow velocities were assessed by Pulsed-wave Doppler performed in the apical 4-chamber view. Ejection fraction (EF) was measured with biplane Simpson's method from the apical 4-chamber view. PW TDI was performed in the apical 4-chamber view to measure mitral annular velocities from the medial and lateral mitral annuli.
The mitral inflow velocities (E, and A) were not correlated to LVEDP while the E/A ratio had a weak positive and the DT of the E wave had a weak negative correlations with LVEDP. E/é ratio showed intermediate to good positive correlation with LVEDP especially those derived from the medial mitral annulus.
The correlation between E/é ratio and LVEDP was similar in the patients with or without significant CAD. The ROC curve showed that the cutoff point of E/ é ratio for predicting LVEDP higher than 15mm Hg was from medial mitral annulus > 15 (sensitivity 77.5 % , specificity 84.6%; P<0.001) and from lateral mitral annulus >10 (sensitivity 79 %, specificity 80.3 %; P < 0.001).
On subgroup classification according to EFs, the E/é medial showed significant but weaker correlation with LVEDP in patients with EF ≥ 50%, as compared to patients with EF < 50 %. E/é lateral and E/é average had poor correlation with LVEDP in patients with EF ≥ 50 %, while they have intermediately significant correlation in patients with EF < 50%.
The TDI derived E/é ratio is better than mitral inflow doppler velocities and intervals for predicting elevated LVEDP in patients with or without significant CAD, especially in patients with reduced EF.
The E/é medial > 15 and E/é lateral > 10, predict LVEDP > 15 mm Hg with good sensitivity and specificity.
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