Clinical Studies
Doppler Tissue Imaging: A Noninvasive Technique for Evaluation of Left Ventricular Relaxation and Estimation of Filling Pressures

https://doi.org/10.1016/S0735-1097(97)00344-6Get rights and content
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Abstract

Objectives. This investigation was designed 1) to assess whether the early diastolic velocity of the mitral annulus (Ea) obtained with Doppler tissue imaging (DTI) behaves as a preload-independent index of left ventricular (LV) relaxation; and 2) to evaluate the relation of the mitral E/Earatio to LV filling pressures.

Background. Recent observations suggest that Eais an index of LV relaxation that is less influenced by LV filling pressures.

Methods. One hundred twenty-five study subjects were classified into three groups according to mitral E/A ratio, LV ejection fraction (LVEF) and clinical symptoms: 34 asymptomatic subjects with a normal LVEF and an E/A ratio ≥1; 40 with a normal LVEF, an E/A ratio <1 and no heart failure symptoms (impaired relaxation [IR]); and 51 with heart failure symptoms and an E/A ratio >1 (pseudonormal [PN]). Eawas derived from the lateral border of the annulus. A subset of 60 patients had invasive measurement of pulmonary capillary wedge pressure (PCWP) simultaneous with Doppler echocardiographic DTI.

Results. Eawas reduced in the IR and PN groups compared with the group of normal subjects: 5.8 ± 1.5 and 5.2 ± 1.4 vs. 12 ± 2.8 cm/s, respectively (p < 0.001). Mean PCWP (20 ± 8 mm Hg) related weakly to mitral E (r = 0.68) but not to Ea. The E/Earatio related well to PCWP (r = 0.87; PCWP = 1.24 [E/Ea] + 1.9), with a difference between Doppler and catheter measurements of 0.1 ± 3.8 mm Hg.

Conclusions. Eabehaves as a preload-independent index of LV relaxation. Mitral E velocity, corrected for the influence of relaxation (i.e., the E/Earatio), relates well to mean PCWP and may be used to estimate LV filling pressures.

Abbreviations

Aa
late diastolic velocity of mitral annulus
DTI
Doppler tissue imaging
Ea
early diastolic velocity of mitral annulus
IR
impaired relaxation
IVRT
isovolumetric relaxation time
LV
left ventricular
LVEF
left ventricular ejection fraction
PCWP
pulmonary capillary wedge pressure
PN
pseudonormal
Sa
systolic velocity of mitral annulus

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