Tissue Doppler imaging in patients with moderate to severe aortic valve stenosis: Clinical usefulness and diagnostic accuracy

Background Mitral annular velocities derived from tissue Doppler imaging (TDI) provide information about left ventricular (LV) long-axis function and allow for the assessment of LV filling pressures in selected subsets of patients. It was the aim of this study to assess the usefulness of TDI in patients with moderate to severe aortic valve stenosis (AS). Methods Twenty-three patients with moderate to severe AS (mean aortic valve area 0.8 ± 0.4 cm2), in whom coronary artery disease had been ruled out, and 36 asymptomatic age-matched control subjects underwent assessment of ejection fraction, fractional shortening, and mitral inflow (E, A, E/A ratio). TDI velocities (Sʹ, Eʹ, Aʹ) were derived from the septal mitral annulus. In patients with AS, LV pressure before atrial contraction (LV pre-A pressure), LV end-diastolic pressure, and cardiac index were measured during cardiac catheterization. Results In patients with AS, systolic (Sʹ) and early diastolic mitral annular velocities (Eʹ) were significantly reduced in comparison to control subjects (systolic, 5.5 ± 1.2 vs 8.3 ± 1.3 cm/s; early diastolic, 5.6 ± 1.6 vs 10.2 ± 3.0 cm/s, P < .001 for both comparisons), but ejection fraction, fractional shortening, and cardiac index were normal. In patients with AS, LV pre-A pressures (14 ± 4 mm Hg) and end-diastolic pressures were high (19 ± 7 mm Hg). In such patients, the mitral E/Eʹ ratio was significantly related to LV pre-A pressure (r = 0.75, P < .001) and to LV end-diastolic pressure (r = 0.78, P < .001). In patients with AS, an E/Eʹ ratio ≥13 identified an LV end-diastolic pressure >15 mm Hg, with a sensitivity of 93% and a specificity of 88%. Conclusions In patients with moderate to severe AS, TDI allows for a reliable, noninvasive estimation of filling pressures. In such patients, systolic long-axis function is impaired even in the presence of normal ejection fraction and cardiac index. Thus, TDI integrates information about systolic and diastolic performance and may be a useful addition in the echocardiographic workup and care of patients with AS.