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Estimation of left ventricular end-diastolic pressure by color M-mode Doppler echocardiography and tissue Doppler
S Dagdelen1, N Eren, H Karabulut
1Kosuyolu Heart and Research Hospital, Kadikoy, Istanbul, Turkey. sinandagdelen@hotmail.com
Insights
Noninvasive estimation of left ventricular end-diastolic pressure (LVEDP) is possible using tissue Doppler imaging and mitral flow propagation velocity. These echocardiographic measurements show utility in assessing LVEDP across different patient groups.
Area of Science:
- Cardiology
- Echocardiography
- Medical Imaging
Background:
- Left ventricular end-diastolic pressure (LVEDP) is a critical parameter for assessing diastolic function.
- Invasive measurement of LVEDP requires cardiac catheterization, which carries risks.
- Noninvasive methods for LVEDP estimation are highly desirable in clinical practice.
Purpose of the Study:
- To evaluate the noninvasive estimation of left ventricular end-diastolic pressure (LVEDP) using tissue Doppler imaging and color M-mode echocardiography.
- To assess the diagnostic accuracy of specific echocardiographic parameters for different LVEDP ranges.
Main Methods:
- Three groups of patients with varying LVEDP (<10, 10-15, >15 mm Hg) were studied.
- Echocardiography was performed, measuring early and late diastolic velocities (Em and Am), Em deceleration time (EmDT), Am time (Am-t), and mitral propagation velocity time delay (VpDT).
Main Results:
- Tissue Doppler imaging parameters demonstrated varying sensitivity and specificity for estimating LVEDP across the studied groups.
- EmDT, Am-t, Em/Am ratio, and VpDT showed potential for noninvasive LVEDP assessment with reported sensitivities and specificities ranging from 0.55 to 0.92.
- Specific thresholds for these parameters were identified for each LVEDP range.
Conclusions:
- Echocardiographic parameters including EmDT, Am-t, Em/Am, and VpDT are useful for noninvasive LVEDP estimation.
- Tissue Doppler imaging and mitral flow propagation velocity offer a valuable noninvasive approach to assess LVEDP.
- These noninvasive measurements can aid in the clinical evaluation of diastolic function.
Objectives:
The aim of this study was to estimate left ventricular end-diastolic pressure (LVEDP) noninvasively by tissue Doppler imaging and color M-mode echocardiography.
Material And Methods:
We studied 3 groups of patients who were proven by angiography to be free of significant coronary artery lesions (<40% stenosis) with an LVEDP < 10 mm Hg (group A: n = 24; 16 men, 18 women; mean age +/- SD = 55 +/- 13 years), an LVEDP of 10 to 15 mm Hg (group B: n = 21; 17 men, 4 women; mean age 56 +/- 11 years), or an LVEDP > 15 mm Hg (group C: n = 35; 20 men, 15 women; mean age 58 +/- 9 years). Tissue Doppler imaging of the lateral mitral annulus and color M-mode imaging of the mitral valve in the apical 4-chamber view were obtained with an echocardiographic system. Early and late diastolic velocities (Em and Am, respectively), Em deceleration time (EmDT), Am time (Am-t), and mitral propagation velocity time delay (VpDT) were measured in each patient.
Results:
In group A, sensitivity and specificity for EmDT < or = 100 ms, Am-t < or = 90 ms, Em/Am > or = 1, and VpDT < or = 45 ms were found to be 0.57 and 0.89, 0.66 and 0.88, 0.86 and 0.92, and 0.73 and 0.89, respectively. In group B, sensitivity and specificity for EmDT 100 to 120 ms, Am-t 90 to 110 ms, Em/Am 1 to 0.5, and VpDT 45 to 60 ms were found to be 0.57 and 0.84, 0.69 and 0.82, 0.66 and 0.75, and 0.55 and 0.83, respectively. In group C, sensitivity and specificity for EmDT > 120 ms, Am-t > 110 ms, Em/Am < 0.5, and VpDT > 60 ms were found to be 0.88 and 0.81, 0.71 and 0.80, 0.86 and 0.72, and 0.78 and 0.86, respectively.
Conclusion:
The EmDT, Am-t, Em/Am, and VpDT measurements obtained noninvasively by left ventricular tissue Doppler imaging and mitral flow propagation velocity were found to be useful in the estimation of LVEDP.
