Document Detail

E/(EaxSa) estimates left ventricular end-diastolic pressure in patients with severe mitral regurgitation.
MedLine Citation:
PMID:  21053735     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND AIM OF THE STUDY: The early diastolic transmitral velocity/early mitral annular diastolic velocity ratio (E/Ea) reflects left ventricular (LV) filling pressure in a variety of cardiac diseases. The value of this parameter in patients with significant mitral regurgitation (MR) remains controversial. It has been hypothesized that, by combining the index of diastolic function (E/Ea) and a parameter that explores LV systolic performance (Sa, mitral annulus peak systolic velocity), a close prediction of the LV end-diastolic pressure (LVEDP) can be provided. Hence, the study aim was to assess the relationship between a new parameter, E/(EaxSa), and LVEDP in patients with severe MR.
METHODS: A total of 55 consecutive patients with severe MR, in sinus rhythm, who had been referred for heart catheterization, was analyzed. Echocardiography was performed simultaneously with LVEDP measurements. Both, E/Ea and E/(EaxSa) were calculated, using the average of the velocities of the septal and lateral mitral annulus.
RESULTS: A significant linear correlation was demonstrated between E/(EaxSa) and LVEDP (r = 0.81, p < 0.001); this was superior to E/Ea (r = 0.73, p < 0.001), Sa (r = -0.59, p = 0.004), pulmonary artery systolic pressure (r = 0.57, p = 0.007), E-wave (r = 0.45, p = 0.009), Ea (r = -0.31, p = 0.01), and left atrial volume (r = 0.28, p = 0.02). No significant relationships could be demonstrated between LVEDP and the LV ejection fraction. The area under the receiver-operating characteristic (ROC) curve for prediction of LVEDP > 15 mmHg was greatest for E/(EaxSa) (AUC = 0.87, p < 0.001), followed by the E/Ea ratio (AUC = 0.81, p < 0.001). A statistical comparison of the ROC curves indicated that E/(EaxSa) was more accurate than E/Ea (p = 0.02). The optimal E/(EaxSa) cut-off to predict a LVEDP > 15 mmHg was 1.95 (85% sensitivity, 83% specificity).
CONCLUSION: E/(EaxSa) correlates strongly with LVEDP, and can serve as a simple and accurate echocardiographic index for the estimation of LVEDP in patients with severe MR.
Cristian Mornoş; Dragoş Cozm; Lucian Petrescu; Adina Ionac; Dan Rusinaru; Stefan-Iosif Dragulescu
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Publication Detail:
Type:  Evaluation Studies; Journal Article    
Journal Detail:
Title:  The Journal of heart valve disease     Volume:  19     ISSN:  0966-8519     ISO Abbreviation:  J. Heart Valve Dis.     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-11-08     Completed Date:  2010-12-02     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9312096     Medline TA:  J Heart Valve Dis     Country:  England    
Other Details:
Languages:  eng     Pagination:  576-83     Citation Subset:  IM    
Institute of Cardiovascular Diseases, Timisoara, Romania.
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MeSH Terms
Blood Flow Velocity / physiology
Blood Pressure / physiology*
Diastole / physiology
Echocardiography, Doppler / methods*
Heart Catheterization
Middle Aged
Mitral Valve / physiopathology*,  ultrasonography*
Mitral Valve Insufficiency / diagnosis,  physiopathology*
Regression Analysis
Severity of Illness Index*
Ventricular Dysfunction, Left / physiopathology*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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