Abstract 14168: The Ratio of Early Diastolic Mitral Flow Velocity to Speckle Tracking Global Longitudinal Strain Rate (novel E/E') Predicts LV Filling Pressure More Accurately than Traditional Tissue Doppler E/E'
Purpose: The ratio of early diastolic mitral flow velocity (E) to tissue Doppler mitral annular velocity (E/E' VEL-TD) is widely used for estimating LV filling pressures. However, it has been reported that E/E' VEL-TD is not accurate when being applied to patients with advanced heart failure. We tested the hypothesis that E/E' measured by 2D speckle tracking (ST) may provide better surrogate marker of elevated PCWP.
Methods: Consecutive 47 ICU patients with heart failure underwent simultaneous echo and PCWP measurements. Patients with elevated (>12) PCWP (n=37, age 60±19) were compared with normals (n=32, age 59±9). In apical 4-chamber view, E/E' VEL-TD, and E to speckle tracking mitral annular velocity (E/E' VEL-ST) were obtained from the septal and lateral annuli, whereas E to early diastolic global longitudinal strain rate (E/E' GSR-ST) was assessed in total LV wall length.
Resuls: E/E' GSR-ST showed significant correlation with PCWP (r=0.53, p<0.001) although traditional E/E' VEL-TD had no significant correlation (Figure 1). Data overlap between patients and normals was the least in E/E' GSR-ST. In ROC analysis for predicting elevated PCWP, E/E' GSR-ST showed the highest accuracy (Sensitivity 0.89, Specificity 0.88, Cutoff 80, AUC 0.95, Figure 2).
Conclusions: Annular velocities do not fully represent global LV dynamics even with the help of tethering phenomenon since it evaluates only basal end of the LV wall. In contrast, global longitudinal strain rate could represent LV dynamics more accurately since it evaluates total LV wall length and is independent of LV geometry and interrogation angle. E/E' GSR-ST would be a robust surrogate marker of elevated LV filling pressure.
- © 2010 by American Heart Association, Inc.