Nunes H, Soares R, Valério L, Pereira H, Branco L, Abreu A, Abreu J, Bernardes L, Sousa M J, Quininha J
Serviço de Cardiologia, Hospital de Santa Marta, Lisboa.
Rev Port Cardiol. 1993 Oct;12(10):841-8, 804-5.
To find a possible correlation between the transmitral diastolic flow, obtained by pulsed Doppler echocardiography, and left ventricular end-diastolic pressure (LVedP), we studied 95 patients (p) (58 +/- 9 years), with coronary artery disease (76 p) and dilated cardiomyopathy (19 p). P with atrial fibrillation, heart rate > 100 b/m or mitral regurgitation > 2+/4+ were excluded. We analyzed E and A wave peak velocities (v), time-velocity integrals (i) and diastolic filling intervals. Restriction to filling pattern was considered in the presence of an E wave deceleration time (DecT) < or = 120 ms (Group B- 22 p); the other 73 p (group A) ranged from abnormal relaxation to normal diastolic patterns, with DecT > 120 ms.
-LVedP ranged from 3 to 38 mmHg in group A and from 16 to 39 mmHg in group B. In group A, the Ai/Ei ratio showed a significant linear correlation with the LVedP (r = 0.83, y = 14 chi + 2); Ai/El ratio > 1.0 identified pts with LVedP > 18 mmHg with a sensitivity of 85% and a specificity of 98%. In group B, there was a correlation between LVedP and the inverse ratio of integrals (Ei/Ai) (r = 0.72), as well as Ev/Av ratio (r = 0.69).
In myocardial active relaxation abnormalities, Ai/Ei ratio increases proportionally to LVedP. A short DecT (< or = 120 ms) identifies a subgroup of p with predominant impairment of LV compliance and high filling pressures, in which the atrial contribution decreases as LVedP rises. Thus, whatever the prevailing mechanism of diastolic dysfunction, echo-Doppler transmitral diastolic flow can provide a noninvasive assessment of LVedP.
