The validity of a global tissue Doppler index in estimating left ventricular end-diastolic pressure in patients with coronary artery disease

摘要

Background The left ventricular end diastolic pressure (LVEDP) is an important parameter in cardiac patients. There are few data on adding tissue Doppler derived mitral annular peak systolic velocity (S′) wave to the ratio of early mitral inflow to mitral annular velocity (E/E′) for the estimation of left ventricular end diastolic pressure (LVEDP) in patients with preserved LV ejection fraction. Objectives To assess the validity of E/(E′? ～ S′) in estimating LVEDP in patients with CAD and intermediate E/E′. Methods Sixty-five subjects underwent echocardiography and TDI of the mitral annulus in less than 30 min of cardiac catheterization. Echocardiographic variables including E/E′ and E/(E′? ～ S′) were compared to invasively measured LVEDP. Results Based on coronary angriography, 49 subjects showed significant CAD (group I) while 16 subjects showed no evidence of CAD (control group). The E/E′ and the E/(E′X S′) were significantly higher in CAD patients than in the control group ( P 0.001). In patients with intermediate E/E′, there was a highly significant positive correlation between the E/(Ex S′) and LVEDP ( r = 0.785, P 0.0001) while the E/E′ showed no significant correlation with the LVEDP in this subset of patients ( r = 0.274, P 0.05). ROC analysis yielded an optimal E/(E′? ～ S′) cutoff value of 1.43 for prediction of LVEDP 12 mmHg with a sensitivity of 90.9%, a specificity of 57.1%, a positive predictive value of 76.9% and a negative predictive value of 80.0% (AUC 0.88, 95% CI 0.71–1.00, P 0.05). The E/E’ ROC cutoff value of 12.2 predicted LVEDP 12 mmHg with a sensitivity of 72.7%, a specificity of 28.6%, a positive predictive value of 61.5% and a negative predictive value of 40.0% (AUC 0.68, 95% CI 0.44–0.93, P 0.05). Conclusions E/(E′? ～ S′) correlates well with LVEDP and can be used as a simple andaccurate estimate ofLVEDP in coronary artery disease patients with intermediate E/E′.