Abstract 2846: Pulsed and Tissue Doppler Indices of Left Atrial Pressure Revisited: Doppler-Catheterization Correlative Studies Demonstrate Their Futility in Advanced Heart Failure Patients
Pulsed and tissue Doppler indices such as mitral flow E/A ratio (E/A), deceleration time (DT), ratio of mitral flow E wave to mitral annular E’ velocities (E/E’), and pulmonary vein systolic to diastolic flow velocity ratio (S/D ratio) have been considered to be indicators of left ventricular diastolic function and filling pressures. The reliability of these indices for gauging LA pressure (pulmonary capillary wedge pressure) in advanced heart failure (HF) patients has not been well studied. The aim of our investigation was to assess the accuracy of these parameters in hospitalized HF patients, in whom information about cardiac filling pressures is clinically important. We measured these indices prospectively in 28 patients hospitalized with HF and LV dysfunction, simultaneously or close to the time of pulmonary capillary wedge pressure (PCWP) measurement by cardiac catheterization and studied their correlation.
Results: The left ventricular ejection fraction was 25±16%, and mean PCWP was 22±7 mmHg (range 2–34 mmHg). The E/A ratio was 1.7±0.7 with a range of 0.7 to 3.2. DT (ms) was 165±52 with a range of 60 to 320. E/E’ ratio (lateral annulus) was 20±18 with a range of 5 to 88. E/E’ ratio (septal) was 25±14, with a range of 6 to 53. The pulmonary vein S/D ratio was 0.9 with a range of 0.4 to 1.9. The correlation between PCW pressure, and E/A ratio, DT, E/E’ ratio (lateral annulus), E/E’ ratio (septal), and pulmonary vein S/D ratio were respectively r=0.29, p=0.289; r=−0.08, p=0.694; r=0.098, p=0.656;r=0.29, p=0.15; r= =−0.33;p=0.11Conclusion: In advanced HF patients, the previously reported pulsed and tissue Doppler indices of left heart filling pressure are unreliable, and thus are not useful for assessment of LA pressure in this population.