Non-Invasive Assessment of Left Ventricular End-Diastolic Pressure in Patients with Chronic Aortic Regurgitation, Comparison of the Sensitivity and Specificity of CW Doppler Echocardiography with Angiography

Background: Left ventricular end diastolic pressure could be estimated collectively using various measures of
mitral valve and pulmonary venous flow velocities. In patients with aortic regurgitation, the AR velocity reflects
the diastolic pressure difference between the aorta and the left ventricle. We sought to predict the left ventricular
end diastolic pressure by a new Doppler index as aortic regurgitation peak early to late diastolic pressure gradient
ratio.
Patients and Methods: Fifty three patients with at least moderate aortic regurgitation were enrolled in this
study. Physical examination, electrocardiography and echocardiography were performed one day before cardiac
catheterization. The severity of AR was graded according to the recommendations of American society for
echocardiography. The pressure half time, aortic regurgitation early diastolic velocity , aortic regurgitation early
diastolic pressure gradient , aortic regurgitation end diastolic velocity, aortic regurgitation end diastolic pressure
gradient, and early diastolic to end diastolic pressure gradient ratio of averaged three beats were measured and
recorded. The results from cardiac catheterization and echocardiography were compared.
Result: The early diastolic to end diastolic pressure gradient ratio was very accurate (80%) for determining the
left ventricular end diastolic pressure (P =0.01). An early diastolic to end diastolic pressure gradient ratio of 1.5
has a sensitivity of 96% and a specificity of 32% for left ventricular end diastolic pressure ≤12 mmHg. The best
cutoff value of early diastolic to end diastolic pressure gradient ratio for the prediction of left ventricular end
diastolic pressure >12 mmHg was higher than 2.0, with a sensitivity of 71% and specificity of 96% We found
no significant correlation between the left ventricular end diastolic pressure with either left ventricular ejection
fraction or aortic regurgitation severity in cardiac catheterization (P =0.5).
Conclusion: Doppler echocardiography is a viable alternative of cardiac catheterization for determination of the
left ventricular end diastolic pressure. The early diastolic to end diastolic pressure gradient ratio is a simple, easy
and new method for assessment of the LVEDP in patients with severe chronic aortic regurgitation.