Early mitral filling/diastolic mitral annular velocity ratio is not a reliable predictor of left ventricular filling pressure in the setting of severe mitral regurgitation.

The early mitral filling velocity (E)/early diastolic mitral annular velocity (E') ratio is increasingly being used as a simplified approach to estimate left ventricular (LV) filling pressure. The validity of applying this Doppler parameter to patients with severe mitral regurgitation is unknown. We retrospectively identified 20 patients in sinus rhythm who had LV end-diastolic pressure (LVEDP) invasively measured within 72 hours of a full echocardiogram including diastolic parameters. We observed a poor correlation between E/E' ratio and LVEDP in these patients (r = -0.07, P = not significant). Previously described E/E' cut-off values did not accurately identify patients with low, intermediate, and high LVEDP. Of the diastolic parameters measured, the most significant correlation with LVEDP was found with mitral deceleration time (r = -0.66, P = .002) and systolic/diastolic peak velocity ratio (r = -0.52, P = .02). We conclude that E/E' ratio is not reliable in predicting LV filling pressure in the setting of severe mitral regurgitation, and that in these cases mitral deceleration time or systolic/diastolic peak velocity ratio may be better indicators of LVEDP.