DOI: 10.1111/j.1540-8175.2011.01408.x C  2011, Wiley Periodicals, Inc. Echocardiographic Evaluation of Left Ventricular Filling Pressures Validated Against an Implantable Left Ventricular Pressure Monitoring System Bj¨ orn Goebel, M.D., ∗ Eva Luthardt, M.D., ∗ Christiane Schmidt-Winter, M.D., ∗ Sylvia Otto, M.D., ∗ Christian Jung, M.D., ∗ Alexander Lauten, M.D., ∗ Hans R. Figulla, Ph.D., ∗ Jan F. Gummert, Ph.D.,†‡ and Tudor C. Poerner, Ph.D. ∗ ∗ 1 st Department of Medicine; †Department of Cardiothoracic Surgery, University Hospital of Jena, Jena, Germany; and ‡ Department of Cardiothoracic Surgery, Herz- und Diabeteszentrum NRW Ruhr-Universit¨ at Bochum, Oeynhausen, Germany Background: Aim of this study was to assess the ability of different echocardiographic indices to evaluate left ventricular (LV) filling pressures in patients with reduced LV function. Methods: In 5 patients sched- uled for aortocoronary bypass surgery, a telemetric intraventricular pressure sensor was implanted. Over 6 months, these patients underwent a total of 21 echocardiographic examinations with a simultaneous recording of left ventricular mean (LVMDP) and end-diastolic pressure (LVEDP). The following echocar- diographic parameters were extracted from the transmitral flow profile: early (E) and late (A) diastolic flow velocity, deceleration time of the E-wave (DT) and the isovolumic relaxation time (IVRT). Early dias- tolic velocity of the mitral ring (E’) was recorded using pulsed-wave tissue Doppler echocardiography. Results: All patients were in NYHA class III and mean ejection fraction was 30%. E correlated only mod- erately with LVMDP (r = –0.60, P = 0.003), but revealed the highest area under the receiver operating characteristic curve for the prediction of an elevated LVMDP > 12 mmHg (AUC = 0.94, sensitivity of 92% and specificity of 86%, cut-off value 7.5 cm/s). E/A > 1 predicted LVEDP > 15 mmHg with a sensitivity of 87% and a specificity of 80%. E/E’ was not correlated with LVMDP or LVEDP. Conclusion: Although linear correlation between echocardiographic parameters and diastolic LV pressures reached statistical significance, the correlation coefficients were low. However, in these patients with severely reduced LV function due to ischemic heart disease conventional echocardiographic parameters of trans- mitral flow showed higher predictive values for elevated LV filling pressures than E/E’. (Echocardiography 2011;28:619-625) Key words: left ventricular filling pressures, heart failure, tissue Doppler echocardiography, telemetric intraventricular pressure sensor Accurate assessment of left-sided intracardiac filling pressures is essential for the management of patients with chronic heart failure, in which congestion causes most of the disabling symp- toms and hospitalizations. High left ventricular filling pressures at rest are associated with in- creased morbidity and mortality. 1,2 Several con- ventional echocardiographic parameters derived from transmitral and pulmonary vein Doppler profiles have been proposed for the noninva- sive prediction of elevated left ventricular diastolic pressures. 3–5 Diastolic mitral annular motion, de- rived by pulsed-wave tissue Doppler echocardiog- raphy (PW-TDE), has been proposed to correct for The authors have no conflicts of interest to disclose. Address for correspondence and reprint requests: Dr. med. B. Goebel, 1 st Department of Medicine, University Hospital of Jena, D-07740 Jena, Germany. Fax +49–3641-9324102; E-mail: goebelbjoern@googlemail.com the influence of myocardial relaxation on trans- mitral flow parameters. In patients with heart failure and preserved global LV function, the ra- tio of early transmitral velocity to tissue Doppler mitral annular early diastolic velocity (E/E’) has been shown to correlate with pulmonary capillary wedge pressure (PCWP) and mean diastolic left ventricular pressure (LVMDP). 6,7 However, there are conflicting results regarding the value of E/E’ for the evaluation of filling pressures in patients with reduced ejection fraction. 8–10 This study was conducted to assess the ability of different echocardiographic indices to evaluate LV filling pressures derived simultaneously from an intraventricular pressure sensor in patients with severely impaired systolic LV function. Methods: Patients: In the clinical pilot study LVP-HF a telemetric left ventricular pressure manometer (LVP-1000 RTM, 619