Validation of six noninvasive Doppler methods for the assessment of left ventricular filling pressure
Nils Kucher1, Markus Schwerzmann, Ernst Lipp
1Swiss Cardiovascular Center, Bern, University Hospital, 3010 Bern, Switzerland. christian.seiler.cardio@insel.ch
Insights
Doppler echocardiography can accurately estimate left ventricular diastolic pressure (LVDP) noninvasively. Mitral regurgitant (MR) Doppler measurements showed the highest accuracy in assessing LVDP compared to other Doppler methods.
Area of Science:
- Cardiology
- Echocardiography
- Diagnostic Tools
Background:
- Assessing left ventricular diastolic pressure (LVDP) noninvasively is crucial for diagnosing and managing cardiac conditions.
- Existing Doppler methods for LVDP estimation lack comparative validation in diverse patient populations.
Purpose of the Study:
- To evaluate the accuracy of six noninvasive Doppler techniques for estimating invasively derived left ventricular diastolic pressure (LVDP).
- To identify the most reliable Doppler method for assessing LVDP across various cardiac diseases.
Main Methods:
- Six Doppler methods were assessed: peak mitral regurgitant flow velocity (M1), mitral regurgitant velocity at aortic valve opening (M2), aortic regurgitant end-diastolic velocity (M3), transmitral/mitral annular velocity ratio (M4), transmitral flow regression equation (M5), and pulmonary/transmitral A wave duration difference (M6).
- LVDP was calculated using Doppler parameters and compared with invasive measurements in 101 patients.
Main Results:
- Mitral regurgitant (MR) Doppler methods (M1 and M2) demonstrated the highest accuracy, with regression coefficients (r) of 0.81 and 0.79, respectively.
- Other methods showed lower accuracy: M3 (r=0.64), M4 (r=0.62), M5 (r=0.24), and M6 (r=0.22).
- M1 and M2 provided the smallest mean differences and confidence intervals compared to invasive LVDP.
Conclusions:
- Noninvasive assessment of mitral regurgitant (MR) Doppler signals is the most accurate method for estimating left ventricular filling pressure.
- These findings support the use of MR Doppler for reliable, noninvasive LVDP assessment in clinical practice.
Objectives:
The aim of this study was to determine the accuracy of six noninvasive Doppler methods for assessing invasively derived left ventricular diastolic pressure (LVDP).
Background:
To date, no studies have evaluated which of the various available Doppler methods are most reliable in determining LVDP in a consecutive patient population with different cardiac diseases.
Methods:
LVDP was estimated by the following Doppler methods (M): (1) M1-the peak mitral regurgitant flow velocity (peak MR), (2) M2-the mitral regurgitant velocity at the time of aortic valve opening (MRAVO), (3) M3-the aortic regurgitant end-diastolic flow velocity (ARED), (4) M4-the ratio of the transmitral to mitral annular early diastolic velocity (ETM/EDTI), (5) M5-a transmitral flow velocity regression equation (RegrTM), and (6) M6-the difference of pulmonary venous and transmitral A wave duration (APV - ATM duration). For M1-M3, sphygmomanometric blood pressure was used to calculate LVDP.
Results:
In 101 patients, the regression coefficient, standard error of estimate, and mean difference with confidence limits between Doppler and catheter-derived measurements were as follows: M1 (n = 46): r = 0.81 (P < 0.0001), 4.3 mmHg and 3.7 +/- 12.0 mmHg; M2 (n = 47): r = 0.79 (P < 0.0001), 5.4 mmHg and 1.1 +/- 11.2 mmHg; M3 (n = 20): r = 0.64 (P = 0.002), 7.8 mmHg and 4.6 +/- 17.6 mmHg; M4 (n = 50): r = 0.62 (P < 0.0001), 5.6 mmHg and 0 +/- 11.2 mmHg; M5 (n = 79): r = 0.24 (P = 0.03), 7.1 mmHg and - 0.1 +/- 16.8 mmHg; and M6 (n = 79): r = 0.22 (P = 0.05), 7.3 mmHg and 0 +/- 14.4 mmHg, respectively.
Conclusions:
The Doppler measurement of mitral regurgitant jets is most accurate method to estimate left ventricular filling pressure noninvasively.
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