In patients with coronary heart disease, evaluation of the left ventricular end diastolic pressure (LVEDP) provides assessment of the hemodynamic severity and aids in assessing the prognosis, and in deciding the proper management and therapeutic interventions. It also helps to distinguish this syndrome from other diseases such as pulmonary disease that can result in dyspnoea.

The early diastolic doppler indexes derived from transmitral flow velocity curves correlated significantly with LV filling pressures in patients with systolic dysfunction, but the correlation was weak in patients with preserved systolic function. The difference between the pulmonary venous and mitral A durations correlated well with LVEDP in patients with CAD, irrespective of the systolic function.

In this study we found echocardiographic doppler derived transmitral and pulmonary venous flow indices can be used as a safe and noninvasive means of predicting the LV filling pressures in patients with coronary artery disease, especially in patients with LV systolic dysfunction, as an alternative to the invasive measurements obtained during cardiac catheterization.

Keywords: Coronary artery Disease (CAD), Left ventricular Ejection Fraction (LVEF), Left ventricular end diastolic pressure (LVEDP), Echo Doppler parameter.

1. Oh JK, Ding ZP, Gersh BJ, Bailey KR, Tajik AJ. Restrictive left ventricular diastolic filling identifies patients with heart failure after acute myocardial infarction. J Am Soc Echocardiogr. 1992; 5: 497–503.
2. Moller JE, Brendorp B, Ottesen M, Kober L, Egstrup K, Poulsen SH, Torp-Pedersen C. Congestive heart failure with preserved left ventricular systolic function after acute myocardial infarction: clinical and prognostic implications. Eur J Heart Fail. 2003; 5: 811–819.
3. Rosamond WD. Invited commentary: trends in coronary heart disease mortality-location, location,location. Am J Epidemiol 2003; 157(9): 771-73.
4. Beinart R, Boyko V, Schwammenthal E, Kuperstein R, Sagie A, Hod H, Matetzky S, Behar S, Eldar M, Feinberg MS. Long-term prognostic significance of left atrial volume in acute myocardial infarction. J Am Coll Cardiol. 2004; 44: 327–334.
5. Nagueh SF, Sun H, Kopelen HA, Middleton KJ,Khoury DS. Hemodynamic determinants of the mitral annulus diastolic velocities by tissue Doppler. J Am Coll Cardiol 2001; 37(1): 278-85.
6. Baan J, van der Velde ET, de Bruin HG, Smeenk GJ, Koops J, van Dijk AD, et al. Continuous measurement of left ventricular volume in animals and humans by conductance catheter. Circulation 1984; 70(5): 812-23.
7. Tanaka N, Dalton N, Mao L, Rockman HA, Peterson KL, Gottshall KR, et al. Transthoracic echocardiography in models of cardiac disease in the mouse. Circulation 1996; 94(5): 1109-17.
8. Meluzin J, Spinarova L, Bakala J, Toman J, Krejci J, Hude P, et al. Pulsed Doppler tissue imaging of the velocity of tricuspid annular systolic motion; a new, rapid, and non-invasive method of evaluating right ventricular systolic function. Eur Heart J 2001; 22(4): 340-8.
9. Ommen SR, Nishimura RA, Appleton CP, Miller FA, Oh JK, Redfield MM, et al. Clinical utility of Doppler echocardio-graphy and tissue Doppler imaging in the estimation of left ventricular filling pressures: A comparative simultaneous Doppler-catheterization study. Circulation 2000; 102(15): 1788-94.
10. Poulsen SH. Clinical aspects of left ventricular diastolic function assessed by Doppler echocardiography following acute myocardial infarction. Dan Med Bull 2001; 48(4): 199-210.
11. Cerisano G, Bolognese L, Buonamici P, Valenti R, Carrabba N, Dovellini EV, Pucci PD, Santoro GM, Antoniucci D. Prognostic implications of restrictive left ventricular filling in reperfused anterior acute myocardial infarction. J Am Coll Cardiol. 2001; 37: 793–799.
12. Garcia-Rubira JC, Garcia-Martinez JT, Hidalgo R, Gomez-Barrado JJ, Rodriguez RM, Rodriguez BJ, Cruz JM. Doppler transmitral flow pattern is an independent prognostic factor in acute myocardial infarction. Cardiology. 1997; 88: 203–20.
13. Rossvoll O, Hatle LK. Pulmonary venous flow velocities recorded by transthoracic Doppler ultrasound: relation to left entricular diastolic pressures. J Am Coll Cardiol 1993;21:1687–96.
14. Nishimura RA, Schwartz RS, Holmes DR Jr, Tajik AJ. Failure of calcium channel blockers to improve ventricular relaxation in humans. J Am Coll Cardiol 1993;21: 182– 8.
15. Masuyama T, Lee JM, Nagano R, et al. Doppler echocardiographic pulmonary venous flow–velocity pattern for assessment of the hemodynamic profile in acute congestive heart failure. Am Heart J 1995;129:107–13.
16. Yamamoto K, Masuyama T, Tanouchi J, et al. Intraventricular dispersion of early diastolic filling: a new marker of left ventricular diastolic dysfunction. Am Heart J 1995;129:291–9.
17. Nishimura RA, Abel MD, Hatle LK, Tajik AJ. Assessment of diastolic function of the heart: background and current applications of Doppler echocardiography. Part Clinical studies. Mayo Clin Proc 1989;64:181-204.
18. Pinamonti B, Di Lenarda A, Sinagra G, Camerini F, for the Heart Muscle Disease Study Group. Restrictive left ventricular filling pattern in dilated cardiomyopathy assessed by Doppler echocardiography: clinical, echocardiographic and hemody-namic correlations and prognostic implica-tions. J Am Coll Cardiol 1993;22:808 –15.
19. Giannuzzi P, Imparato A, Temporelli PL, et al. Doppler-derived mitral deceleration time of early filling as a strong predictor of pulmonary capillary wedge pressure in postinfarction patients with left ventricular systolic dysfunction. J Am Coll Cardiol 1994;23:1630 –7.
20. Masuyama T, Lee JM, Nagano R, et al. Doppler echocardiographic pulmonary venous flow–velocity pattern for assessment of the hemodynamic profile in acute congestive heart failure. Am Heart J 1995;129:107–13.
21. Kuecherer HF, Muhiudeen IA, Kusumoto FM, et al. Estimation of mean left atrial pressure from transesophageal pulsed Doppler echocardiography of pulmonary venous flow. Circulation 1990;82:1127–39.
22. Ishida Y, Meisner JS, Tsujioka K, et al. Left ventricular filling dynamics: influence of left ventricular relaxation and left atrial pressure. Circulation 1986;74:187–96.
23. Choong CY, Herrmann HC, Weyman AE, Fifer MA. Preload dependence of Doppler-derived indexes of left ventricular diastolic function in humans. J Am Coll Cardiol 1987;10:800–8.
24. Choong CY, Abascal VM, Thomas JD, Guerrero JL, McGlew S, Weyman AE. Combined influence of ventricular loading and relaxation on the transmitral flow velocity profile in dogs measured by Doppler echocardiography. Circulation 1988;78:672– 83.
25. Yamamoto K, Masuyama T, Tanouchi J, et al. Peak early diastolic filling velocity may decrease with preload augmentation:effect of concomitant increase in the rate of left atrial pressure drop in early diastole. J Am Soc Echocardiogr1993;6:245–54.
26. Thomas JD, Newell JB, Choong CY, Weyman AE. Physical and physiological determinants of transmitral velocity: numerical analysis. Am J Physiol 1991;260:H1718–31.
27. Thomas JD, Weyman AE. Echocardio-graphic Doppler evaluation of left ventricular diastolic function: physics and physiology. Circulation 1991;84:977–90.
28. Yamamoto K, Masuyama T, Tanouchi J, et al. Importance of left ventricular minimal pressure as a determinant of transmitral flow velocity pattern in the presence of left ventricular systolic dysfunction. J Am Coll Cardiol 1993;21: 662–72.
29. Eichhorn EJ, Willard JE, Alvarez L, et al. Are contraction and relaxation coupled in patients with and without congestive heart failure ? Circulation 1992;85:2132–9.
30. Matsuda Y, Toma Y, Matsuzaki M, et al. Change of left atrial systolic pressure waveform in relation to left ventricular end-diastolic pressure. Circulation 1990;82:1659–67.
31. Quinones MA, Waggoner AD, Reduto LA, et al. A new, simplified and accurate method for determining ejection fraction with two-dimensional echocardiography. Circulation 1981;64:744 –53.
32. Ommen SR, Nishimura RA, Appleton CP, Miller FA, Oh JK, Redfield MM, Tajik Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: a comparative simultaneous Doppler-  catheterization study. Circulation. 2000; 102: 1788–1794.
33. Nagueh SF, Kopelen HA, Quinones MA. Assessment of left ventricular filling pressures by Doppler in the presence of atrial fibrillation. Circulation. 1996; 94: 2138–2145
34. Nagueh SF, Mikati I, Kopelen HA, Middleton KJ, Quinones MA, Zoghbi WA. Doppler estimation of left ventricular filling pressure in sinus tachycardia: a new application of tissue Doppler imaging. Circulation. 1998; 98: 1644–1650.
35. Bruch C, Stypmann J, Gradaus R, Breithardt G, Wichter T. Usefulness of tissue Doppler imaging for estimation of filling pressures in patients with primary or secondary pure mitral regurgitation. Am J Cardiol. 2004; 93: 324–328.
36. Nagueh SF, Lakkis NM, Middleton KJ, Spencer WH III, Zoghbi WA, Quinones MA. Doppler estimation of left ventricular filling pressures in patients with hypertrophic cardiomyopathy. Circulation. 1999; 99: 254–261.
37. Yamamoto K, Nishimura RA, Chaliki HP, Appleton CP, Holmes DR Jr, Redfield MM. Determination of left ventricular filling pressure by Doppler echocardiography in patients with coronary artery disease: critical role of left ventricular systolic function. J Am Coll Cardiol 1997;30:1819–26.
38. Rossvoll O, Hatle LK. Pulmonary venous flow velocities recorded by transthoracic Doppler ultrasound: relation to left ventricular diastolic pressures. J Am Coll Cardiol 1993;21:1687–96.
39. F. Nagueh, C. P. Appleton, T. C. Gillebert et al., “Recommendations for the evaluation of left ventricular diastolic function by echocardiography,” European Journal of Echocardiography, vol. 10, no. 2, pp. 165–193, 2009.
40. Okura, T. Kubo, K. Asawa et al., “Elevated E/E′ predicts prognosis in congestive heart failure patients with preserved systolic function,” Circulation Journal, vol. 73, no. 1, pp. 86–91, 2009.

Lipika Adhikary

Assistant Professor, Cardiology Department, R.G Kar Hospital, Kolkata

Address: C/O Manoj Adhikary, Schooldanga, Bankura, West Bengal, India, Pin- 722101