"Pre-ejection Flow Wave" (BeST Wave): a new marker of increased left ventricular diastolic filling pressure.

Background. The clinical significance of pre-ejection flow wave seen on Doppler study of the left ventricular (LV) outflow tract remains unexplored. We hypothesized that its prominence is associated with elevated left ventricular end-diastolic pressure (LVEDP) since it was frequently observed in patients with less compliant ventricles. We sought to investigate the velocity of this pre-ejection wave, determine its association with left ventricular end diastolic pressure (LVEDP) and establish a cut-off value that best predicts an elevated LVEDP.

Methods. This is a prospective study involving seventy patients in sinus rhythm with adequate systolic function who underwent Doppler measurement of pre-ejection wave followed by LVEDP determination. Pearson's Correlation Coefficient, Student's t-test, Receiver Operating Characteristic (ROC) curve & Kappa test were applied to analyze data. P-value

Results. There was good correlation between level of velocity and LVEDP (R=0.76, p<0.0001). Velocities were significantly higher in patients with LVEDP >15mmHg than with LVEDP 15 with sensitivity, specificity, PPV & NPV of 100%, 80%,80% & 100% respectively. Velocity ~ OAOm/s predicted LVEDP >20 with sensitivity, specificity, PPV and NPV of 80%, 90%, 75% & 92% respectively.

Conclusion. Pre-ejection flow wave is associated with elevated LVEDP. This parameter provides a new clinical tool in predicting elevated LVEDP and can be utilized with other validated Doppler-derived measures of LV diastolic filling pressure.