Estimation of LV End‐Diastolic Pressure Using Color‐TDI and Its Application to Noninvasive Quantification of Myocardial Wall Stress

Abstract

Background: This study was undertaken to evaluate early-diastolic annular velocity (Ea) by color-TDI, combined with the early transmitral filling velocity (E) by pulsed Doppler echocardiographyfor estimation of left ventricular end diastolic pressure (LVEDP). We applied LVEDP to noninvasivequantification of myocardial wall stress in end-diastole. Forty-one coronary artery disease (CAD)patients with sinus rhythm underwent echocardiography and cardiac catheterization evaluated inthe study. Methods: First linear regression analysis was performed to assess the relationships betweenE/Ea and LVEDP. Second LVEDP estimation with these two methods was tested prospectively in 59additional CAD patients, and average end-diastolic wall stress was calculated at rest by measuringthe principal radii, the thickness of the LV segments, and the estimated LVEDP. The results werecompared to the wall stress that was calculated using catheter-measured LVEDP. Linear regressionanalysis was performed to assess the relationships between calculated wall stress using Doppler-estimated LVEDP (WSEP) and calculated wall stress using catheter-measured LVEDP (WSMP).Results: The results showed that LVEDP had a strong correlation to the lateral E/Ea (r = 0.85; P <0.001) and medial E/Ea ratios (r = 0.73; P < 0.001). No significant differences were found between theWSEP and WSMP. There were highly significant correlations (at least r = 0.85, P < 0.001) betweenthe WSMP and WSEP at all the myocardial sites. Conclusions: The current data demonstrate thatthe lateral E/Ea ratio obtained by Doppler echocardiography and color-TDI is a powerful estimator ofLVEDP in CAD patients and provides pressure information required for noninvasive quantificationof LV myocardial wall stress with reasonable accuracy in diastole. (ECHOCARDIOGRAPHY, Volume26, April 2009