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Background: Various conventional and tissue Doppler parameters have been proposed for the estimation of left ventricular filling pressure.Aim: To assess the utility of several conventional and tissue Doppler parameters in the estimation of left ventricular end diastolic pressure (LVEDP).Method: Among 40 consecutive patients invasively estimated LVEDP was correlated with pulsed Doppler of mitral inflow (peak E and A velocities, E wave deceleration time) and pulsed tissue Doppler of lateral mitral annulus (peak E' and A' velocities, acceleration time and rate of E' and A', deceleration time and rate of E' and A'). Time difference between onset of E and E' was estimated. These ratios were calculated: E/A, E'/A', E/ E', and E to myocardial isovolumic relaxation time.Results: Among all studied Doppler variables, E'/A' ratio showed the most significant correlation with LVEDP (r=0.612, p <0.001). Among patients with grade II and III diastolic dysfunction (n=20), E'/A' ratio showed the best correlation with LVEDP (r=0.81, p<0.001) with the following regression equation: LVEDP = 1.77 + (20.4 × E'/A'), while in patients with grade I diastolic dysfunction no correlation existed (r=0.11, p=0.63). Weak significant correlation was detected between E/E' ratio and LVEDP (r=0.382, p=0.016). An E/E' ratio ≥ 12 had 25% sensitivity and 100% specificity to identify patients with elevated LVEDP (> 15 mmHg) with a positive predictive value of 100%. On the other hand, an E/E' ratio of ≤ 8 had 77% sensitivity and 57% specificity to identify patients with normal LVEDP with a negative predictive value of 31%.Conclusion: Of all echocardiographic variables investigated, E'/A' ratio was identified as the best index to estimate LVEDP especially in patients with advanced LV diastolic dysfunction; a relation that was not found for other studied conventional or tissue Doppler variables including the E/E' ratio.