Clinical utility of doppler echocardiography and tissue doppler imaging in the estimation of left Ventricular Filling Pressures英文电子书.pdf

Clinical Utility of Doppler Echocardiography and Tissue Doppler Imaging in the Estimation of Left Ventricular Filling Pressures A Comparative Simultaneous Doppler-Catheterization Study S.R. Ommen, MD; R.A. Nishimura, MD; C.P. Appleton, MD; F.A. Miller, MD; J.K. Oh, MD; M.M. Redfield, MD; A.J. Tajik, MD Background—Noninvasive assessment of diastolic filling by Doppler echocardiography provides important information about left ventricular (LV) status in selected subsets of patients. This study was designed to assess whether mitral annular velocities as assessed by tissue Doppler imaging are associated with invasive measures of diastolic LV performance and whether additional information is gained over traditional Doppler variables. Methods and Results—One hundred consecutive patients referred for cardiac catheterization underwent simultaneous Doppler interrogation. Invasive measurements of LV pressures were obtained with micromanometer-tipped catheters, and the mean LV diastolic pressure (M-LVDP) was used as a surrogate for mean left atrial pressure. Doppler signals from the mitral inflow, pulmonary venous inflow, and TDI of the mitral annulus were obtained. Isolated parameters of transmitral flow correlated with M-LVDP only when ejection fraction 50%. The ratio of mitral velocity to early diastolic velocity of the mitral annulus (E/E) showed a better correlation with M-LVDP than did other Doppler variables for all levels of systolic function. E/E 8 accurately predicted normal M-LVDP, and E/E 15 identified increased M-LVDP. Wide variability was present in those with E/E of 8 to 15. A subset of those patients with E/E 8 to 15 could be further defined by use of other Doppler data. Conclusions—The comb