Determination of left ventricular filling parameters by pulsed Doppler echocardiography: a noninvasive method to predict high filling pressures in patients with coronary artery disease.

This study investigated the influence of left ventricular end-diastolic filling pressure (LVEDP) on instantaneous transmitral inflow velocities as assessed by pulsed Doppler echocardiography. The study was performed in 87 consecutive patients with coronary artery disease (12 women, 65 men, mean age 58 +/- 8 years, range 37 to 78 years) in whom Doppler tracings of mitral inflow velocities were recorded 24 hours before diagnostic cardiac catheterization. The ratio of early-to-late diastolic velocity integrals was significantly correlated with LVEDP (r = 0.35, SD = 0.77, p less than 0.001). In addition, in a comparison patients with LVEDP greater than or equal to 20 mm Hg to those with LVEDP less than 20 mm Hg, peak early filling velocity (R) was significantly higher, peak late filling velocity (A) was lower, and hence R/A and area under the early filling curve/area under the late diastolic filling curve (E/L) ratios were significantly higher in patients with markedly elevated filling pressures (LVEDP 20 mm Hg: R = 41 +/- 12, A = 56 +/- 16, R/A = 0.75 +/- 0.23, E/L = 1.0 +/- 0.4, n = 54, and LVEDP greater than or equal to 20 mm Hg: R = 49 +/- 18, A = 46 +/- 12, R/A = 1.23 +/- 0.9, E/L = 1.94 +/- 1.2, n = 34. An E/L ratio greater than or equal to 1.4 showed a sensitivity of 59%, a specificity of 83%, a positive predictive accuracy of 69%, and a negative predicting accuracy of 76% in detecting patients with markedly elevated LVEDP.(ABSTRACT TRUNCATED AT 250 WORDS)