The left ventricular end diastolic pressure (LVEDP) is an important parameter which reflects volume status in critically ill patients. Noninvasive assessment by Doppler echocardiography provides a safe and reproducible investigation comparable with invasive pressure monitoring. Aim: This study was designed to evaluate the role of tissue Doppler imaging (TDI) variables in the assessment of LVEDP.Methods: Patients scheduled for cardiac catheterization were studied with Doppler echocardiography immediately before the procedure. Early and late mitral inflow velocity (E, A wave respectively) and peak diastolic velocity from medial and lateral mitral annulus (Ea medial, Ea lateral) were obtained. Invasive measurement of LVEDP was obtained with a fluid filled pigtail catheter. The results were blinded to the interpreter.Results: There were 50 patients (mean age 53.6+9.7years, mean ejection fraction [EF] 57.7+ 11.9%). Significant coronary lesions were found in 84% of this group. The correlation between LVEDP and E, Ea medial or Ea lateral were significant (r = 0.20, p=0.0001: r = -0.7, p<0.0001 and r = -0.4, p=0.01 respectively). The ratio of E/Ea medial had the strongest correlation with LVEDP (r = 0.8, p< 0.0001). E/Eamedial > 10 accurately predicted LVEDP > 15 mmHg with 77% sensitivity and 88.7% specificity. In patients with EF>50%, the correlation between E/Eamedial and LVEDP was still significant (r = 0.7, p< 0.0001). Conclusion: E/ Ea medial correlates well with LVEDP and can be used to estimate LVEDP in coronary artery disease patients even in patients with normal LVEF.