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Doppler estimation of left ventricular filling pressures in patients with hypertrophic cardiomyopathy
S F Nagueh1, N M Lakkis, K J Middleton
1Department of Medicine, Section of Cardiology, Baylor College of Medicine at Houston, TX, USA. sherifin@bcm.tmc.edu
Insights
New echocardiography methods accurately estimate left ventricular (LV) filling pressures in hypertrophic cardiomyopathy (HCM). These techniques, using E velocity/flow propagation velocity and E/Ea ratios, also track pressure changes effectively.
Area of Science:
- Cardiology
- Echocardiography
- Cardiovascular Physiology
Background:
- Conventional Doppler parameters are inadequate for assessing left ventricular (LV) filling pressures in hypertrophic cardiomyopathy (HCM).
- Novel echocardiographic indices are needed to reliably estimate filling pressures in HCM patients.
Purpose of the Study:
- To evaluate the utility of flow propagation velocity and early diastolic annular velocity (Ea), combined with mitral E velocity, for estimating LV filling pressures in HCM.
- To assess if these novel indices can track changes in filling pressures.
Main Methods:
- Thirty-five HCM patients underwent simultaneous LV catheterization and echocardiography.
- Measurements included mitral E velocity, flow propagation velocity (color M-mode), and Ea (tissue Doppler).
- Correlation and prospective testing were used to validate the estimation methods.
Main Results:
- LV pre-atrial pressure showed weak correlation with traditional Doppler parameters.
- LV pre-atrial pressure correlated strongly with E velocity/flow propagation velocity (r=0.67) and E/Ea (r=0.76).
- These ratios accurately tracked changes in filling pressures in repeat measurements and prospective testing (r values up to 0.82).
Conclusions:
- E velocity/flow propagation velocity and E/Ea provide reasonable accuracy for estimating LV filling pressures in HCM.
- These echocardiographic ratios are valuable tools for monitoring filling pressures in HCM patients.
Background:
Conventional Doppler parameters are unreliable for estimating left ventricular (LV) filling pressures in hypertrophic cardiomyopathy (HCM). This study was undertaken to evaluate flow propagation velocity by color M-mode and early diastolic annular velocity (Ea) by tissue Doppler 2 new indices of LV relaxation, combined with mitral E velocity for estimation of filling pressures in HCM.
Methods And Results:
Thirty-five HCM patients (52+/-15 years) underwent LV catheterization simultaneously with 2-dimensional and Doppler echocardiography. Pulsed Doppler echocardiography of mitral and pulmonary venous flows was obtained along with flow propagation velocity and Ea. LV preA pressure had weak or no relations with mitral, pulmonary venous velocities and atrial volumes. In contrast, preA pressure related strongly to E velocity/flow propagation velocity (r=0.67; SEE=4) and E/Ea (r=0.76; SEE=3.4). In 17 patients with repeat measurements, preA pressure changes were well detected by measuring E velocity/flow propagation velocity (r=0.68; P=0.01) or E/Ea (r=0.8; P<0.001). PreA pressure estimation with these 2 methods was tested prospectively in 17 additional HCM patients with good results (E velocity/flow propagation velocity, r=0.76; E/Ea, r=0.82).
Conclusions:
LV filling pressures can be estimated with reasonable accuracy in HCM patients by measuring E velocity/flow propagation velocity or E/Ea. These ratios also track changes in filling pressures.
