Estimation of Left Ventricular Filling Pressure with Exercise by Doppler Echocardiography in Patients with Normal Systolic Function: A Simultaneous Echocardiographic-Cardiac Catheterization Study

Deepak R. Talreja, Rick A. Nishimura, Jae Kuen Oh

Research output: Contribution to journalArticle

80 Citations (Scopus)

Abstract

Background: Doppler echocardiography is now used to evaluate left ventricular filling pressures in patients at rest. However, the clinical use of Doppler echocardiography in the determination of filling pressures with exercise has been less well studied. Objective: The aim of this prospective study was to confirm the validity of an accepted Doppler parameter (ratio of transmitral E velocity to Doppler tissue annular e' velocity [E/e']) as a measure of filling pressure in patients with normal systolic function during rest and exercise. Methods: Twelve patients who presented with symptoms of dyspnea and ejection fraction greater than 50% underwent an exercise right heart catheterization during a symptom-limited bicycle exercise test. Simultaneous Doppler assessment of transmitral flow and tissue Doppler annulus motion was recorded. Results: The transmitral E velocity increased from 0.88 ± 0.2 to 1.29 ± 0.4 cm/s whereas the mitral annular e' velocity increased from 0.08 ± 0.02 to 0.11 ± 0.06 with exercise. The E/e' ratio increased from 11.7 ± 0.5 to 14.4 ± 0.6. Pulmonary artery wedge pressure (PAWP) increased from 14 ± 4 to 23 ± 10 mm Hg at peak exercise. The sensitivity of an E/e' of 15 or less as a predictor for a normal PAWP during exercise was 89%. Conversely, in all cases where the E/e' was greater than 15, the PAWP was elevated during exercise. Conclusion: Noninvasively obtained Doppler of mitral and mitral annulus velocities provides a reliable estimation of PAWP not only at baseline, but also with exercise. Specifically, an E/e' ratio of greater than 15 during exercise is associated with a significantly elevated PAWP of greater than 20 mm Hg.

Original languageEnglish (US)
Pages (from-to)477-479
Number of pages3
JournalJournal of the American Society of Echocardiography
Volume20
Issue number5
DOIs
StatePublished - May 2007

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Doppler Echocardiography
Ventricular Pressure
Cardiac Catheterization
Exercise
Pulmonary Wedge Pressure
Pressure
Exercise Test
Dyspnea
Prospective Studies

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

@article{8162739f7ece488d9e6da856fe3e936e,
title = "Estimation of Left Ventricular Filling Pressure with Exercise by Doppler Echocardiography in Patients with Normal Systolic Function: A Simultaneous Echocardiographic-Cardiac Catheterization Study",
abstract = "Background: Doppler echocardiography is now used to evaluate left ventricular filling pressures in patients at rest. However, the clinical use of Doppler echocardiography in the determination of filling pressures with exercise has been less well studied. Objective: The aim of this prospective study was to confirm the validity of an accepted Doppler parameter (ratio of transmitral E velocity to Doppler tissue annular e' velocity [E/e']) as a measure of filling pressure in patients with normal systolic function during rest and exercise. Methods: Twelve patients who presented with symptoms of dyspnea and ejection fraction greater than 50{\%} underwent an exercise right heart catheterization during a symptom-limited bicycle exercise test. Simultaneous Doppler assessment of transmitral flow and tissue Doppler annulus motion was recorded. Results: The transmitral E velocity increased from 0.88 ± 0.2 to 1.29 ± 0.4 cm/s whereas the mitral annular e' velocity increased from 0.08 ± 0.02 to 0.11 ± 0.06 with exercise. The E/e' ratio increased from 11.7 ± 0.5 to 14.4 ± 0.6. Pulmonary artery wedge pressure (PAWP) increased from 14 ± 4 to 23 ± 10 mm Hg at peak exercise. The sensitivity of an E/e' of 15 or less as a predictor for a normal PAWP during exercise was 89{\%}. Conversely, in all cases where the E/e' was greater than 15, the PAWP was elevated during exercise. Conclusion: Noninvasively obtained Doppler of mitral and mitral annulus velocities provides a reliable estimation of PAWP not only at baseline, but also with exercise. Specifically, an E/e' ratio of greater than 15 during exercise is associated with a significantly elevated PAWP of greater than 20 mm Hg.",
author = "Talreja, {Deepak R.} and Nishimura, {Rick A.} and Oh, {Jae Kuen}",
year = "2007",
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T1 - Estimation of Left Ventricular Filling Pressure with Exercise by Doppler Echocardiography in Patients with Normal Systolic Function

T2 - A Simultaneous Echocardiographic-Cardiac Catheterization Study

AU - Talreja, Deepak R.

AU - Nishimura, Rick A.

AU - Oh, Jae Kuen

PY - 2007/5

Y1 - 2007/5

N2 - Background: Doppler echocardiography is now used to evaluate left ventricular filling pressures in patients at rest. However, the clinical use of Doppler echocardiography in the determination of filling pressures with exercise has been less well studied. Objective: The aim of this prospective study was to confirm the validity of an accepted Doppler parameter (ratio of transmitral E velocity to Doppler tissue annular e' velocity [E/e']) as a measure of filling pressure in patients with normal systolic function during rest and exercise. Methods: Twelve patients who presented with symptoms of dyspnea and ejection fraction greater than 50% underwent an exercise right heart catheterization during a symptom-limited bicycle exercise test. Simultaneous Doppler assessment of transmitral flow and tissue Doppler annulus motion was recorded. Results: The transmitral E velocity increased from 0.88 ± 0.2 to 1.29 ± 0.4 cm/s whereas the mitral annular e' velocity increased from 0.08 ± 0.02 to 0.11 ± 0.06 with exercise. The E/e' ratio increased from 11.7 ± 0.5 to 14.4 ± 0.6. Pulmonary artery wedge pressure (PAWP) increased from 14 ± 4 to 23 ± 10 mm Hg at peak exercise. The sensitivity of an E/e' of 15 or less as a predictor for a normal PAWP during exercise was 89%. Conversely, in all cases where the E/e' was greater than 15, the PAWP was elevated during exercise. Conclusion: Noninvasively obtained Doppler of mitral and mitral annulus velocities provides a reliable estimation of PAWP not only at baseline, but also with exercise. Specifically, an E/e' ratio of greater than 15 during exercise is associated with a significantly elevated PAWP of greater than 20 mm Hg.

AB - Background: Doppler echocardiography is now used to evaluate left ventricular filling pressures in patients at rest. However, the clinical use of Doppler echocardiography in the determination of filling pressures with exercise has been less well studied. Objective: The aim of this prospective study was to confirm the validity of an accepted Doppler parameter (ratio of transmitral E velocity to Doppler tissue annular e' velocity [E/e']) as a measure of filling pressure in patients with normal systolic function during rest and exercise. Methods: Twelve patients who presented with symptoms of dyspnea and ejection fraction greater than 50% underwent an exercise right heart catheterization during a symptom-limited bicycle exercise test. Simultaneous Doppler assessment of transmitral flow and tissue Doppler annulus motion was recorded. Results: The transmitral E velocity increased from 0.88 ± 0.2 to 1.29 ± 0.4 cm/s whereas the mitral annular e' velocity increased from 0.08 ± 0.02 to 0.11 ± 0.06 with exercise. The E/e' ratio increased from 11.7 ± 0.5 to 14.4 ± 0.6. Pulmonary artery wedge pressure (PAWP) increased from 14 ± 4 to 23 ± 10 mm Hg at peak exercise. The sensitivity of an E/e' of 15 or less as a predictor for a normal PAWP during exercise was 89%. Conversely, in all cases where the E/e' was greater than 15, the PAWP was elevated during exercise. Conclusion: Noninvasively obtained Doppler of mitral and mitral annulus velocities provides a reliable estimation of PAWP not only at baseline, but also with exercise. Specifically, an E/e' ratio of greater than 15 during exercise is associated with a significantly elevated PAWP of greater than 20 mm Hg.

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