Noninvasive prediction of left ventricular end-diastolic pressure in patients with coronary artery disease and preserved ejection fraction

Background

The aim of this study was to compare 3 different available methods for estimating left ventricular end-diastolic pressure (LVEDP) noninvasively in patients with coronary artery disease and preserved left ventricular ejection fraction (EF).

Methods

We used 3 equations for noninvasive estimation of LVEDP: The equation of Mulvagh et al., LVEDP₁ = 46 ? 0.22 (IVRT) ? 0.10 (AFF) ? 0.03 (DT) ? (2 ÷ E/A) + 0.05 MAR; the equation of Stork et al., LVEDP₂ = 1.06 + 15.15 × Ai/Ei; and the equation of Abd-El-Aziz, LVEDP₃ = 0.54 (MABP) × (1 ? EF)] ? 2.23. (Abbreviations: A, A-wave velocity; AFF, atrial filling fraction; Ai, time velocity integral of A wave; DT, deceleration time; E, E-wave velocity; Ei, time velocity integral of E wave; IVRT, isovolumic relaxation time; MABP, mean arterial blood pressure; MAR, time from termination of mitral flow to the electrocardiographic R wave; Ti, time velocity integral of total wave.)

Results

LVEDP measured by catheterization was correlated with LVEDP₁ (r = 0.52, P < 0.001), LVEDP₂ (r = 0.31, P < 0.05), and LVEDP₃ (r = 0.81, P < 0.001).

Conclusions

The equation described by Abd-El-Aziz, LVEDP = 0.54 MABP × (1 ? EF)] ? 2.23, appears to be the most accurate, reliable, and easily applied method for estimating LVEDP noninvasively in patients with preserved left ventricular ejection fraction and an LVEDP < 20 mm Hg.