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|Title: ||Tissue Doppler Imaging in the estimation of intracardiac filling pressure in decompensated patients with advanced systolic heart failure|
|Authors: ||Mullens, Wilfried|
Borowski, Allen G.
Curtin, Ronan J.
Thomas, James D.
|Issue Date: ||2009|
|Citation: ||CIRCULATION, 119 (1), p. 62-70|
|Abstract: ||Background—The ratio of early transmitral velocity to tissue Doppler mitral annular early diastolic velocity (E/Ea) has
been correlated with pulmonary capillary wedge pressure (PCWP) in a wide variety of cardiac conditions. The objective
of this study was to determine the reliability of mitral E/Ea for predicting PCWP in patients admitted for advanced
decompensated heart failure.
Methods and Results—Prospective consecutive patients with advanced decompensated heart failure (ejection fraction
30%, New York Heart Association class III to IV symptoms) underwent simultaneous echocardiographic and
hemodynamic evaluation on admission and after 48 hours of intensive medical therapy. A total of 106 patients were
included (mean age, 57 12 years; ejection fraction, 24 8%; PCWP, 21 7 mm Hg; mitral E/Ea ratio, 20 12). No
correlation was found between mitral E/Ea ratio and PCWP, particularly in those with larger left ventricular volumes,
more impaired cardiac indexes, and the presence of cardiac resynchronization therapy. Overall, the mitral E/Ea ratio was
similar among patients with PCWP 18 and 18 mm Hg, and sensitivity and specificity for mitral E/Ea ratio 15 to
identify a PCWP 18 mm Hg were 66% and 50%, respectively. Contrary to prior reports, we did not observe any direct
association between changes in PCWP and changes in mitral E/Ea ratio.
Conclusion—In decompensated patients with advanced systolic heart failure, tissue Doppler– derived mitral E/Ea ratio
may not be as reliable in predicting intracardiac filling pressures, particularly in those with larger LV volumes, more
impaired cardiac indices, and the presence of cardiac resynchronization therapy.|
|Type: ||Journal Contribution|
|Appears in Collections: ||Research publications|
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