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The Origin and Clinical Significance of the Signal Opposite to the Mitral E‐Wave: A Simple and Novel Indicator of Left Ventricular Filling Pressure

Objectives: We noted a low‐velocity signal opposite to the early diastolic transmitral flow (E) by pulsed Doppler echocardiography. The purpose of this study was to examine the origin and significance of this signal. Background: The background of the signal remains uncertain. Methods: We studied 59 adult patients (34 men and 25 women; mean age, 58.9 [20.2] years) without mitral valve heart disease. Mitral E‐wave velocity and the signal (EW) opposite the E‐wave were measured by pulsed Doppler echocardiography. Early diastolic mitral valve ring motion velocity (Ea) was measured by pulsed tissue Doppler echocardiography. Pulmonary capillary wedge pressure (PCWP) was measured by a Swan‐Ganz catheter in 34 of the 59 patients. Results: A blue signal was observed during early diastole from the mitral valve ring to the mitral orifice areas by color tissue Doppler echocardiography. The velocity profile method revealed the same direction and time between peak Ea and EW. Peak EW positively correlated with Ea (r = 0.67, P < 0.01). There were significant positive correlations between mean PCWP and E/Ea (r = 0.61, P < 0.01) and E/EW (r = 0.59, P < 0.01). E/EW was significantly greater in patients with PCWP > 12 mmHg than in patients with PCWP ≤ 12 mmHg (5.6 [1.3] cm/s vs. 4.3 [0.9] cm/s, P < 0.01). Conclusions: EW may be related to mitral valve ring motion, and the E/EW ratio may be a noninvasive simple parameter for assessing left ventricular filling pressure. (Echocardiography 2011;28:606‐611)