Usefulness of Tissue Doppler Imaging for Assessing Left Ventricular Filling Pressure in Patients With Stable Severe Systolic Heart Failure

The ratio of early transmitral blood flow velocity over tissue Doppler early diastolic mitral annulus velocity (E/e′) was found unreliable for estimating pulmonary capillary wedge pressure (PCWP) in patients with decompensated systolic heart failure (HF). The objective of this study was to test its reliability in stable HF. Therefore, 130 consecutive patients with a left ventricular (LV) ejection fraction of 15 mm Hg. E/e′ septal correlated more strongly with PCWP (r = 0.53) compared with E/e′ lateral (r = 0.41) and E/e′ mean (r = 0.50; all p values septal , 0.72 (95% CI 0.63 to 0.82) for E/e lateral , and 0.79 (95% CI 0.70 to 0.87) for E/e mean (all p values septal and E/e mean did not vary with s′ septal , QRS width, or resynchronization. Using a cutoff of 8, negative predictive value of E/e′ septal was 89% and negative likelihood ratio of 0.15. E/e′ lateral showed good diagnostic performance only in patients with s′ lateral of >4.5 cm/s (n = 77, 59%; AUC = 0.82; 95% CI 0.71 to 0.92; s′ lateral of ≤4.5 cm/s: AUC = 0.54; 95% CI 0.38 to 0.70; p = 0.005). In conclusion, e′ is useful for estimating LV filling pressure in stable severe systolic HF. E/e′ septal showed good diagnostic performance for detecting normal filling pressures.