Indexing peak rapid filling velocity to both relaxation and filling volume to estimate left ventricular filling pressures

Aims: The peak transmitral velocity/peak mitral annular velocity (E/e′) ratio has been used as a left ventricular (LV) filling pressure (LVFP) correlate. However, the E/e′ and its changes with haemodynamic alterations have not always correlated with changes in LVFP's. We hypothesized that indexing E/e′ to a measure of LV filling volume may enhance the correlation with LVFP and LVFP changes. Methods and results: We summarized previously obtained haemodynamic and Doppler echo data in 137 dogs with coronary microsphere embolization induced-chronic LV dysfunction prior to and following haemodynamic induced alterations in LVFP's. E/e′ values were obtained as E∗tau where tau is the inverse logarithmic LV pressure decay. E∗tau was indexed to LV filling volume by dividing by the diastolic time velocity integral (DVI) and correlated with LV mean diastolic pressure (LVmDP). Similarly, the relationship of E/e′ and E/e′/DVI to LV pre A wave pressure was evaluated in 84 patients by invasive haemodynamics and Doppler echo. Combining data from all interventions, LVmDP correlated with E∗tau (r = 0.408) but more strongly with E∗tau/DVI (r = 0.667, z = 3.03, P = 0.0008). The change in LVmDP correlated with the change in E∗tau/DVI (r = 0.742) more strongly than E∗Tau (r = 0.187, Z = 4.01, P < 0.0001). In the patient cohort, E/e′ was modestly correlated with LV pre A wave pressure (r = 0.301) but more strongly correlated with E/e′/DVI (r = 0.636, z = 2.36, P = 0.0161). Conclusion: Indexing E to both LV relaxation and filling volume results in a more robust relation with LVFP's and with LVFP changes.