Assessment of left ventricular diastolic pressure in the emergency room and intensive care unit: a new Doppler index

Introduction

Assessment of left ventricular diastolic pressure (LVDP) by transthoracic echocardiography (TTE) contributes to the diagnosis of dyspnea in the emergency room and ICU. Classical parameters are derived from mitral blood flow recorded using pulsed Doppler (maximal velocity of early and late mitral wave: E and A), mitral annulus movement using Doppler tissue imaging (early lateral mitral annulus movement: Ea) and early left ventricular inflow propagation velocity (Vp) using M-mode color Doppler. Unfortunately, Doppler tissue imaging and M-mode color Doppler are not always available on echocardiography machines and these measurements are also time-consuming.

Objective

In this study, we propose a new simple index obtained exclusively from mitral flow recorded by pulsed Doppler: E/DTE (DTE: deceleration time of E).

Method

We analysed the sensitivity and specificity of classical indices of LVDP (E/A, E/Ea, E/Vp) and this new index in order to determine their ability to discriminate cardiogenic and noncardiogenic dyspnea.

One hundred and twenty-five patients with acute dyspnea were studied by echocardiography (80 in the emergency room, 45 in the ICU). Cardiogenic dyspnea was defined at hospital discharge on the basis of clinical examination, classical echocardiographic parameters, and clinical course during hospital stay.

Results

Forty-four percent of patients were considered to have cardiogenic dyspnea and 72% were in sinus rhythm allowing interpretation of the E/A ratio.

Sensitivity and specificity of the parameters analyzed are presented in Table 1 for all patients and for patients in sinus rhythm.

Table 1 Sensitivity and specificity: patients have cardiogenic dyspnea if the values of the different parameters are over the threshold value

Conclusion

In conclusion, we demonstrated that E/DTE is a very simple, rapidly recorded and highly sensitive and specific index to discriminate cardiogenic and noncardiogenic dyspnea in patients admitted to the emergency room or ICU with normal or altered left ventricular systolic function, whether or not they are in sinus rhythm.