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Title: Tissue Doppler Imaging in the estimation of intracardiac filling pressure in decompensated patients with advanced systolic heart failure
Authors: Mullens, Wilfried 
Borowski, Allen G.
Curtin, Ronan J.
Thomas, James D.
Tang, W.H.
Issue Date: 2009
Source: CIRCULATION, 119 (1), p. 62-70
Abstract: Background—The ratio of early transmitral velocity to tissue Doppler mitral annular early diastolic velocity (E/Ea) has been correlated with pulmonary capillary wedge pressure (PCWP) in a wide variety of cardiac conditions. The objective of this study was to determine the reliability of mitral E/Ea for predicting PCWP in patients admitted for advanced decompensated heart failure. Methods and Results—Prospective consecutive patients with advanced decompensated heart failure (ejection fraction 30%, New York Heart Association class III to IV symptoms) underwent simultaneous echocardiographic and hemodynamic evaluation on admission and after 48 hours of intensive medical therapy. A total of 106 patients were included (mean age, 57 12 years; ejection fraction, 24 8%; PCWP, 21 7 mm Hg; mitral E/Ea ratio, 20 12). No correlation was found between mitral E/Ea ratio and PCWP, particularly in those with larger left ventricular volumes, more impaired cardiac indexes, and the presence of cardiac resynchronization therapy. Overall, the mitral E/Ea ratio was similar among patients with PCWP 18 and 18 mm Hg, and sensitivity and specificity for mitral E/Ea ratio 15 to identify a PCWP 18 mm Hg were 66% and 50%, respectively. Contrary to prior reports, we did not observe any direct association between changes in PCWP and changes in mitral E/Ea ratio. Conclusion—In decompensated patients with advanced systolic heart failure, tissue Doppler– derived mitral E/Ea ratio may not be as reliable in predicting intracardiac filling pressures, particularly in those with larger LV volumes, more impaired cardiac indices, and the presence of cardiac resynchronization therapy.
Keywords: diastole; echocardiography; heart failure; hemodynamics; remodeling
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ISSN: 0009-7322
e-ISSN: 1524-4539
DOI: 10.1161/CIRCULATIONAHA.108.779223
Category: A1
Type: Journal Contribution
Appears in Collections:Research publications

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