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 echocardiography for estimation of left ventricular end diastolic pressure (LVEDP). We applied LVEDP to noninvasive quantification of myocardial wall stress in end-diastole. Forty-one coronary artery disease (CAD) patients with sinus rhythm underwent echocardiography and cardiac catheterization evaluated in the study. Methods: First linear regression analysis was performed to assess the relationships between E/Ea and LVEDP. Second LVEDP estimation with these two methods was tested prospectively in 59 additional CAD patients, and average end-diastolic wall stress was calculated at rest by measuring the principal radii, the thickness of the LV segments, and the estimated LVEDP. The results were compared to the wall stress that was calculated using catheter-measured LVEDP. Linear regression analysis was performed to assess the relationships between calculated wall stress using Dopplerestimated 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 the WSEP and WSMP. There were highly significant correlations (at least r = 0.85, P < 0.001) between the WSMP and WSEP at all the myocardial sites. Conclusions: The current data demonstrate that the lateral E/Ea ratio obtained by Doppler echocardiography and color-TDI is a powerful estimator of LVEDP in CAD patients and provides pressure information required for noninvasive quantification of LV myocardial wall stress with reasonable accuracy in diastole.

Evaluation of left anterior descending coronary artery stenosis severity from myocardial end‐diastolic wall stress estimated by tissue‐Doppler imaging

“…Off-line analysis was performed by the imbedded quantitative analysis software, and regional myocardial velocity was measured on tissue velocity curves from the 5-mm sample volume placed within the lateral mitral annulus. 7,8,13 The gain was minimized so that the onset of the early-diastolic mitral annulus displacement could be reliably identified. ECG analysis was performed by an experienced observer who was unaware of the patient's angiographic results.…”

“…LVEDP 50:441 1:363 lateralE=Ea ð Þ ½ It has been shown that the correlation coefficient between LVEDP and lateral E/Ea is higher and its limits of agreement are smaller than those of other mitral segments. 7,8,13,17 Therefore, we used only lateral E/Ea ratio for the estimation of LVEDP and quantification of myocardial wall stress.…”

“…3 Systolic and diastolic wall stress has been determined by combining simultaneous measurements of left ventricular pressures with angiographic and echocardiographic measurements of left ventricular radius and wall thickness. [4][5][6][7] These methods, in addition to being cumbersome and time-consuming, require invasive procedures. The noninvasive assessment of left ventricular end-diastolic pressure (LVEDP) provides important information on the hemodynamic status 8 and may be an important clinical tool in these patients, offering the possibility of noninvasively quantifying myocardial wall stress in end-diastole.…”

“…This requires analysis of the forces and stresses developed in the wall of the left ventricle (LV), which has been evaluated in terms of myocardial wall stress . Systolic and diastolic wall stress has been determined by combining simultaneous measurements of left ventricular pressures with angiographic and echocardiographic measurements of left ventricular radius and wall thickness . These methods, in addition to being cumbersome and time‐consuming, require invasive procedures.…”

“…Wall stress may be calculated at the diastolic phase of the cardiac cycle; however, this calculation requires measurements of LV blood pressure. Recently, we demonstrated the possibility of using color‐coded tissue Doppler imaging (color‐TDI) for the estimation of LVEDP in patients with CAD. An advantage of color‐TDI is its ability to obtain simultaneously data from several sites (for instance, the lateral and medial parts of the mitral annulus) and the ability to quantify mean myocardial velocities…”