P452 Tissue Doppler Imaging (TDI) for Estimation of Filling Pressures - Validation in Patients with Primary or Secondary Mitral Regurgitation.
Chr.Bruch, J.Stypmann, L.Eckardt
Med. Klinik und Poliklinik C, Universität Münster, Münster.

Background: Mitral annular velocities derived from by tissue Doppler imaging (TDI) complement traditional variables in the evaluation of left ventricular (LV) performance. The mitral E/E-ratio has been suggested as an estimate of LV filling pressures. However, E/E has not been validated in patients with primary or secondary mitral regurgitation (MR).

Methods& Results: 14 patients (pts.) with primary MR (prolapse (n=6), flail leaflet (n=3), rheumatic degeneration (n=3); mean grade 3.2±0.3, PMR group), 26 pts. with MR secondary due to ischemic (n=19) or dilated cardiomyopathy (n=7) (mean grade 2.7±0.3, SMR group) and 29 controls (CON group) underwent measurements of ejection fraction (EF) and mitral inflow velocities (E, A, E/A-ratio). TDI derived mitral annular velocities (S, E, A) were obtained at the septal mitral annulus. In pts., LV end-diastolic pressure (LVEDP) was derived from left heart catheterization.

* p <0.05 vs. CON group, # <0.01 PMR vs. SMR goup.
Group EF (%) Mitral E/A-ratio S' (cm/s) E' (cm/s) A' (cm/s) E/E' LVEDP (mmHg)
CON (n=29) 67± 8 1.20± 0.35 8.8± 1.3 11.6± 2.5 11.3± 2.0 6.5± 1.5
PMR (n=14) 70± 10 1.74± 0.64 10.2± 2.5 12.3± 2.5 11.2± 2.1 8.5± 3.4 13± 6
SMR (n=26) 30 ± 11*# 2.12± 1.32* 4.7± 1.1*# 5.7± 1.3*# 6.9± 2.5*# 16.2± 4.5*# 20± 6#

E/E was significantly related to LVEDP in the SMR group (r=0.61, p<0.001), but not in the PMR group (r=0.17, p=ns). In the SMR group, an E/E>13.5 identified pts. with LVEDP >15 mmHg with a sensitivity 80% of and a specifity of 83%.

Conclusion: In subjects with secondary MR and reduced LV performance, E/E is a reliable estimate of filling pressures. In subjects with primary SV and preserved LV performance, filling pressures are underestimated by E/E, mainly due to increased E.