The usefulness of tissue doppler imaging in the determination of left ventricular diastolic filling pressure. Comparison with other techniques

The further examination of left ventricular diastolic function (LVDF) is important in terms of early diagnosis, therapy and follow-up of heart failure. Although cardiac catheterization is considered as the most accurate method in the evaluation of diastolic function, since it is invasive, noninvasive methods are preferred. This study was undertaken to examine whether mitral annular velocities assessed by pulsed tissue Doppler imaging (PTDI) were associated with invasive measures of diastolic LV pressure and whether additional information was gained over traditional transmitral and pulmonary venous flow velocity parameters. Doppler examination was performed in 102 patients referred to our clinic for cardiac catheterization. Doppler signals from the mitral inflow, pulmonary venous inflow, and PTDI of the mitral annulus were obtained. Mean left ventricular diastolic pressure (M-LVDP) was measured.The relationship between echocardiographic parameters and M-LVDP was investigated.A significant correlation was observed between M-LVDP and E/septal Em (r = 0.52, p < 0.000), E/lateral Em (r = 0.45, p < 0.0001), E/posterior Em (r = 0.46, p < 0.0001) E/anterior Em (r = 0.49, p < 0.0001), E/mean Em (r = 0.49, p < 0.0001), PVadur - MVadur (r = 0.51, p < 0.0001). The best echocardiographic parameters correlating with M-LVDP were E/septal Em and PVa-dur - MVa-dur. In conclusion, PTDI could be used in the assessment of LVDP. However, the combination of transmitral flow and pulmonary venous flow velocities with annular velocity can be proposed as the best method for assessing LV filling pressure that combines the influence of transmitral driving pressure and myocardial relaxation.