From the Section of Cardiology, Baylor College of Medicine and The
Methodist Hospital, Echocardiography, Houston, Tex.
Correspondence to William A. Zoghbi, MD, Director, Echocardiography Research, Baylor College of Medicine and Methodist Hospital, 6550 Fannin SM-677, Houston, TX 77030. E-mail wzoghbi{at}bcm.tmc.edu
Background—Doppler
echocardiography is frequently used to predict
filling pressures in normal sinus rhythm, but it is unknown whether it
can be applied in sinus tachycardia, with merging of E and
A velocities. Tissue Doppler imaging (TDI) can record the
mitral annular velocity. The early diastolic velocity
(Ea) behaves as a relative load-independent index of left
ventricular relaxation, which corrects the influence of
relaxation on the transmitral E velocity.
Methods and Results—We evaluated 100 patients 64±12 years old
with simultaneous Doppler and invasive
hemodynamics. Mitral inflow was classified into 3
patterns: complete merging of E and A velocities (pattern A),
discernible velocities with A dominance (B), or E dominance (C). The
Doppler data were analyzed at the mitral valve tips for E,
acceleration and deceleration times of E, and isovolumic relaxation
time. In patterns B and C, the A velocity, E/A ratio, and atrial
filling fraction were derived. Pulmonary venous flow velocities
were also measured, and TDI was used to acquire Ea and
Aa. Weak significant relations were observed between
pulmonary capillary wedge pressure (PCWP) and sole
parameters of mitral flow, pulmonary venous flow,
and annular measurements. These were better for patterns A and C.
E/Ea ratio had the strongest relation to PCWP
[r=0.86, PCWP=1.55+1.47(E/Ea)],
irrespective of the pattern and ejection fraction. This equation was
tested prospectively in 20 patients with sinus tachycardia.
A strong relation was observed between catheter and Doppler PCWP
(r=0.91), with a mean difference of 0.4±2.8
mm Hg.
Conclusions—The ratio of transmitral E velocity to Ea
can be used to estimate PCWP with reasonable accuracy in sinus
tachycardia, even with complete merging of E and A
velocities.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Doppler Estimation of Left Ventricular Filling Pressure in Sinus Tachycardia
A New Application of Tissue Doppler Imaging
Key Words: tachycardia • diastole • pressure • echocardiography
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