Abstract 13397: The Impact of Sample Volume Placement on E/e’ Measurements: Different Reference Thresholds
Pulsed wave tissue Doppler imaging (TDI) has become an integral part of the echocardiographic assessment of diastolic left ventricular (LV) function. Used in combination with mitral inflow velocity (E) the ratio of E to annular velocity (e’), E/e’, is a surrogate for LV filling pressure. We sought to define the difference between E/e’ assessed at the septal or lateral mitral annulus and developed reference ranges for each.
Methods: We used the EchoNoRMAL database, which is an individual-person meta-analysis that includes population-based echocardiographic data from adults aged 18-80 free of cardiovascular disease and/or risk factors. This analysis is restricted to 2924 adults with both septal and lateral pulsed wave TDI. We compared the mean (standard deviation) E/e’ for each location and determined predictors of E/e’ using linear regression. Using a centile regression approach, we determined age appropriate upper reference values for each site (95th centile).
Results: Mean pulsed wave TDI-derived septal E/e’ was higher than lateral E/e’ in men: 7.7(2.1) vs 5.9(1.8)(p<0.001); and women: 7.8(2.3) vs 6.1(1.9)(p<0.001). E/e’ septal was not significantly different between genders (p=0.10) however E/e’ lateral was (p=0.0003). E/e’ increased with age, and in gender-specific multivariable analyses, E/e’ septal was associated with age but not heart rate or systolic blood pressure (SBP). E/e’ lateral was associated with age and SBP. The 95th centile of E/e’ in men at age 50 was 11.0 (septal) and 8.6 (lateral), and in women 11.4 (septal) and 9.2 (lateral).
Conclusion: This study has documented the significant difference in E/e’ derived from the septum and lateral walls, and small but significant differences were observed between genders at both sites. The upper reference value varied by gender and sample volume location. These differences have implications for the clinical utility of E/e’ measurements.
- © 2013 by American Heart Association, Inc.