Key result
The E/Ea ratio reliably estimated LVEDP in primary mitral regurgitation (medial annulus cutoff >14 yielded 90% sensitivity and 83% specificity for LVEDP ≥15 mmHg) but not in secondary MR.
Why the study?
Does the E/Ea ratio reliably estimate LVEDP in patients with primary and secondary mitral regurgitation?
Cross-Sectional (n=96)
Does the E/Ea ratio reliably estimate LVEDP in patients with primary and secondary mitral regurgitation?
The E/Ea ratio is a reliable noninvasive estimator of LVEDP in patients with primary mitral regurgitation, but it is not predictive in patients with ischemic secondary mitral regurgitation.
Supports E/Ea for LVEDP estimation in primary MR; leaves open its role in secondary MR pending prospective validation.
BACKGROUND: The ratio of early transmitral flow velocity to mitral annulus early diastolic velocity (E/Ea) is a widely used noninvasive tool to estimate left ventricular end diastolic pressure (LVEDP). The aim of this study was to explore whether E/Ea ratio was a reliable index for the estimation of LVEDP in patients with mitral regurgitation (MR). METHODS: Sixteen patients with nonischemic MR (primary MR group; 6 male, 58 ± 12 years) 51 patients with ischemic MR (secondary MR group; 29 male, 63 ± 9 years) and 29 patients without MR (control group; 19 male, 53 ± 10 years) were consecutively included. The peak transmitral flow and mitral annular velocities during early diastole were measured. LVEDP was determined invasively by left heart catheterization. RESULTS: Primary and secondary MR groups had significantly higher E/Ea ratios and LVEDP than control group. LVEDP significantly correlated with E/Ea ratio in patients with primary MR, but not in patients with secondary MR. Multiple regression analysis revealed that E/Ea ratio was an independent predictor of LVEDP in patients with primary MR. Ten patients with primary MR had LVEDP ≥15 mmHg. ROC analysis demonstrated cutoff values for E/Ea ratios as >10.5 for lateral mitral annulus (sensitivity: 80%, specificity: 66%, PPV: 80%, NPV: 66%) and as >14 for medial mitral annulus (sensitivity: 90%, specificity: 83%, PPV: 90%, NPV: 83%) to predict primary MR patients with LVEDP ≥15 mmHg. CONCLUSION: E/Ea ratio is still reliable in estimation of LVEDP in primary MR patients while it is not predictive for LVEDP in secondary MR patients.
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Yeşildağ et al. (2011) conducted a cross-sectional in Mitral regurgitation (n=96). Tissue Doppler Imaging (E/Ea ratio) vs. Invasive left heart catheterization was evaluated on Correlation of E/Ea ratio with LVEDP and prediction of LVEDP ≥15 mmHg. The E/Ea ratio reliably estimated LVEDP in primary mitral regurgitation (medial annulus cutoff >14 yielded 90% sensitivity and 83% specificity for LVEDP ≥15 mmHg) but not in secondary MR.
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