Determination of left ventricular filling pressure by new echocardiographic methods in patients with coronary artery disease

Aim The present study was designed to determine the reliability of the analysis of the time difference between onset of mitral inflow and onset of early diastolic mitral annulus velocity and mean systolic strain index, and comparing them with E/E′ in the detection of increased left ventricular end-diastolic pressure (LVEDP) in patients with coronary artery disease. Methods Eighty patients (mean age: 57.2 ± 11.5 years) referred for cardiac catheterization were studied. Patients were divided into 2 groups according to LVEDP (group 1: LVEDP > 20 mmHg, n = 39 patients; group 2: LVEDP ≤20 mmHg, n = 41 patients). From the mitral inflow, peak E velocity was calculated. With tissue Doppler echocardiography, early diastolic velocity (E′) measured from the septal, lateral, inferior and lateral mitral annulus and mean value of E′ and E/E′ ratio were calculated. The time difference between onset of mitral inflow and onset of early diastolic mitral annulus velocity (T_E′-E) was calculated. From the apical chambers, the peak systolic strain value of 16 left ventricular (LV) segments was measured and the mean of these 16 segments was calculated and referred to as mean systolic strain index. Results The patients with increased LVEDP (group 1) had a higher E/E′ ratio (13.8 ± 3.4 vs. 9.9 ± 2.8, P < 0.001) and lower mean systolic strain index (11.8 ± 3.4 % vs. 13.5 ± 3.6 %, P = 0.038) than patients in group 2. The sensitivity of E/E′ > 13.42 for identifying LVEDP > 20 mmHg was 71%, with a specificity of 89%. The sensitivity of a mean systolic strain index < 10.57% for identifying LVEDP > 20 mmHg was 44%, with a specificity of 83%. T_E′-E was not significantly different between the two groups. Conclusion The decreased longitudinal function of the left ventricle is related to increased LVEDP. The E/E’ ratio, which in recent years has been used for the prediction of LV filling pressures, was a better predictor for increased LVEDP than the mean systolic strain score index and the time difference between onset of mitral inflow and onset of early diastolic mitral annulus velocity in patients with coronary artery disease.