TABLE 3.

Pros and cons of tissue Doppler-derived early diastolic velocity to early diastolic annular velocity ratio (E/Ea) and B-type natriuretic peptide for the estimation of left ventricular filling pressures

B-type natriuretic peptide	E/Ea
Pros
Point-of-care	High specificity
Inexpensive	Accompanying echocardiographic Doppler information, is very useful to
Rapid result	determine cause of dyspnea
Excellent negative predictive value	Can be used in obese patients
Well validated for clinical congestive heart failure, less so with invasive hemodynamic indexes	Rapidly changes in response to volume changes Validated in multiple studies and patient populations
Cons
‘Gray zone’	‘Gray zone’
Low specificity	In general, not point-of-care
Renal failure can create false-positive results	More expensive
Unclear use in obese patients	Can be unclear in patients with poor echocardiographic windows
Cannot distinguish among causes of heart failure (valvular, diastolic, restrictive, right ventricular, etc)	Not well validated in mitral valve disease (stenosis, regurgitation, prosthesis)
	Not well validated in nonsinus rhythm
Unclear use in atrial fibrillation
B-type natriuretic peptide ‘memory’ – may not respond rapidly to volume changes