Noninvasive Prediction of Left Ventricular End-Diastolic Pressure in Patients With Coronary Artery Disease and Preserved Ejection Fraction

Background: The aim of this study was to compare 3 different available methods for estimating left ventricular end-diastolic pressure (LVEDP) noninvasively in patients with coronary artery disease and preserved left ventricular ejection fraction (EF). Methods: We used 3 equations for noninvasive estimation of LVEDP: The equation of Mulvagh et al., LVEDP1 = 46 - 0.22 (IVRT) - 0.10 (AFF) - 0.03 (DT) - (2 divided by E/A) + 0.05 MAR; the equation of Stork et al., LVEDP2 = 1.06 + 15.15 x Ai/Ei; and the equation of Abd-El-Aziz, LVEDP3 = [0.54 (MABP) x (1 - EF)] - 2.23. (Abbreviations: A, A-wave velocity; AFF, atrial filling fraction; Ai, time velocity integral of A wave; DT, deceleration time; E, E-wave velocity; Ei, time velocity integral of E wave; IVRT, isovolumic relaxation time; MABP, mean arterial blood pressure; MAR, time from termination of mitral flow to the electrocardiographic R wave; Ti, time velocity integral of total wave.) Results: LVEDP measured by catheterization was correlated with LVEDP1 (r = 0.52, P < 0.001), LVEDP2 (r = 0.31, P < 0.05), and LVEDP3 (r = 0.81, P < 0.001). Conclusions: The equation described by Abd-El-Aziz, LVEDP = [0.54 MABP x (1 - EF)] - 2.23, appears to be the most accurate, reliable, and easily applied method for estimating LVEDP noninvasively in patients with preserved left ventricular ejection fraction and an LVEDP < 20 mm Hg.