Abstract 11798: The Usefulness of Combined Assessment of E/e’ Ratio and Transmitral Flow Pattern to Interpret Cardiac Condition
Background: High mitral inflow E velocity to tissue Doppler e’ ratio (E/e’) is implicated as increased left ventricular (LV) filling pressure, but it is not always consistent with clinical findings. Early (E) and late (A) diastolic filling velocity ratio (E/A) is also used to evaluate LV diastolic function and filling pressure, but the usefulness of combined assessment of E/e’ and E/A is not fully understood.
Methods: We retrospectively analyzed 1266 patients who underwent echocardiography to assess cardiac function between January 2013 to March 2014 in our hospital. The patients were grouped based on the values of E/e’ (low E/e’<15, high E/e’≥15) and E/A (low E/A≤0.8, high E/A>0.8).
Results: First, we analyzed a role of E/A in the setting of high E/e’ condition. The low E/A with high E/e’ group (n=95) displayed lower tricuspid regurgitant pressure gradient (TRPG, 22 [16-28] mmHg vs. 29 [23-38] mmHg, P<0.01) and smaller inferior vena cava (IVC) diameter (12 [10-15] mm vs. 14 [11-17] mm, P<0.01) than the high E/A with high E/e’ group (n=136), suggesting that low E/A indicated controlled fluid retention even with high E/e’. We next investigated the role of E/e’ in the situation of low E/A state. Compared to the low E/A with low E/e’ group (n=584), the low E/A with high E/e’ group showed similar TRPG (22 [16-28] mmHg vs. 21 [17-26] mmHg, ns), similar IVC diameter (12 [10-15] mm vs. 12 [10-15] mm, ns), but larger LV end-diastolic diameter (48 [42-52] mm vs. 45 [40-50] mm, P<0.01), larger left atrial volume (53 [38-67] ml vs. 41 [29-54] ml, P<0.01), lower LV ejection fraction (59 [47-66]% vs. 63 [57-67]%, P<0.01), and slower LV systolic velocity (5.9 [4.9-7.3] cm/s vs. 7.8 [6.5-9.5] cm/s, P<0.01), indicating that high E/e’ was a predictor of LV remodeling and dysfunction in the situation of low E/A condition.
Conclusions: The low E/A indicated controlled fluid retention regardless of E/e’ value. A high E/e’ reflected LV remodeling and dysfunction. Thus, we conclude that combined assessment of E/e’ and E/A is useful to interpret cardiac condition.
Author Disclosures: M. Oikawa: None. A. Kobayashi: None. H. Yamauchi: None. S. Suzuki: None. A. Yoshihisa: None. K. Nakazato: None. H. Suzuki: None. S. Saitoh: None. Y. Takeishi: None.
- © 2014 by American Heart Association, Inc.