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A ratio15 between the early diastolic pulsed Doppler velocities of the mitral inflow (E) and the basal left ventricular (LV) tissue (e) has been demonstrated to predict an elevated LV filling pressure (FP). An elevated LVFP implies an elevated right ventricular pressure (RVp). In order to investigate the sensitivity of the E/e filling index, we compared E/e and RVp, in their ability to identify a Doppler-assumed elevation of LVFP.Application of pulsed Doppler international recommendations grouped 134 patients with acute coronary syndromes (ACS) and 50 age- and sex-matched controls, according to LV filling: normal; delayed relaxation; an isolated pathological mitral-pulmonary venous-A-wave-duration difference; pseudo normal; or a restrictive filling pattern. An E/e15 and an RVp30 mmHg showed the following (%) sensitivity (32/94), specificity (95/76), positive (68/59), and negative (80/97) predictive values of a Doppler-assumed elevation of LVFP, in terms of either a pseudo normal or a restrictive filling pattern.The low sensitivity of E/e to detect a Doppler-assumed elevation of LVFP could limit its clinical usefulness as a single variable, in ACS. The high sensitivity and negative predictive value of RVp support its use as an additional LV filling variable in these patients.

Echocardiography combining Doppler and two-dimensional data is recommended for quantitative assessments of valvular regurgitation. We applied a new method to calculate the mitral annulus (MA) area in combination with multiple sample sites. Individuals without regurgitation in whom the valvular and left ventricular stroke volumes (SV) should be identical were investigated in order to evaluate the feasibility in quantitative assessments of valvular regurgitation.Twenty subjects were included. Flow velocity was registered with pulsed Doppler in different positions in the left ventricular outflow tract (LVOT) and in the MA. The MA area was assumed to be either circular, using the diameter from a four-chamber projection, or elliptic, using the major diameter from a parasternal short axis and a minor diameter from an apical long axis. Left ventricular (LV) SV was measured from LV volumes using the biplane method. The overall difference between LVOT SV and mitral SV using one centrally located measurement and elliptic MA was 3.2+/-15.6 ml (P=0.38), 0.9+/-15.7 ml between LVOT SV and LV SV (P=0.80) and -2.2+/-15.2 ml between mitral SV and LV SV (P=0.54). The corresponding standard deviation of the differences as a percentage of the mean value was 24%, 25% and 23%. A circular shaped MA overestimated the mitral SV compared with LVOT SV (P=0.009) and LV SV (P=0.004). Increasing the number of sample sites in the LVOT or MA did not further improve the results.Doppler and two-dimensional echocardiography can be used to quantify regurgitation in groups of patients. In individual patients the wide distribution of differences between valves and LV SV implies that the method should be used in conjunction with other Doppler echocardiographic parameters.

Background: Right heart catheterization (RHC) is required to confirm diagnosis and estimate severity of pulmonary arterial hypertension (PAH). Recent improvements in medical therapy for this group of patients have increased the need for follow-up assessment of treatment efficacy. The aim of the study was to evaluate the possibilities for a complete hemodynamic assessment including pulmonary vascular resistance (PVR) using a new Doppler echocardiographic approach in patients with PAH. Methods: Thirty patients with established PAH underwent RHC and Doppler echocardiography (DE) at 44 occasions. The investigations were performed within two days in 86% of the cases. The tricuspid regurgitant (TR) velocity was registered from multiple windows and was used to estimate peak systolic (PAs) and late diastolic (PAd) pressure (Bernoulli). At the time of pulmonary valve opening right chamber pressure equals PAd. Tricuspid velocity at the time of pulmonary valve opening was measured by superimposing the time from QRS to the onset of flow in the pulmonary valve on the TR envelope. Mean pulmonary pressure (PAm) was calculated as PAd+0.33 (PAs-PAd). Left atrial pressure (LAP) was evaluated by integrating mitral flow, pulmonary venous and tissue Doppler information. The right atrial (RAP) pressure was estimated by the inferior vena cava method and cardiac output (CO) using standard DE method. Results: The LAP was normal (