Echocardiographic predictors of left ventricular filling pressure: Comparison of multiple indices

Objectives: It has been shown that both pulmonary venous flow and changes in mitral inflow pattern caused by reduced preload are useful in predicting left ventricular filling pressure. Our aim was to test the hypothesis that a combined application of different methods could improve the hemodynamic evaluation. Methods: 43 patients (pts) with catheterization determined wedge pressure (PCWP) were studied with transthoracic and transesophageal echocardiography. The Doppler data at the mitral valve tips were analyzed for the peak E and A velocities, E at onset of A, E/A, acceleration time, deceleration time of E and A, atrial filling fraction and isovolumic relaxation time. Tissue Doppler imaging (TDI) of the mitral annulus was used to acquire its diastolic velocities Ea and Aa. Parameters from transesophageal pulmonary venous systolic (S), diastolic (D), atrial reverse waves (Ar) and systolic fraction (SF) were also measured. Results: The ratio of E/Ea had the strongest relation to PCWP (r = 0.85, PCWP = 1.53 + 1.48 E / Ea) irrespective of the mitral filling pattern. Univariate analysis revealed that only E/Ea was associated with PCWP (p = 0.007). Multivariate analysis showed the combination of SF + E / Ea to be most predictive of PCWP (chi square = 11.8, p = 0.009). Conclusions: This study suggests that combining pulmonary venous and mitral annular indices is most promising as an echocardiographic means to evaluate left ventricular filling pressure.