E/a′ ratio is closely related to pulmonary vein flow profile in patients with normal ejection fraction

Objectives. To compare the ability of the E/a′ ratio and the recommended diastolic parameters in the American Society of Echocardiography (ASE) and the European Association of Cardiovascular Imaging (EACVI), in predicting a dominant diastolic pulmonary vein flow in patients with normal ejection fraction. Design. We retrospectively evaluated the diastolic function according to the ASE/EACVI guidelines, the S/D ratio and the septal, lateral and average E/a′ ratio in 293 unselected in-hospital patients, aged 39–86 years, in sinus rhythm and with no or mild valve disease, having a normal systolic function (EF > 50%). Results. The S/D ratio had a positive association to septal, lateral and average E/a ratio (R2 = 0.25, 0.35 and 0.32). The association to average E/e′ ratio, LA vol index and TR velocity was weak (R2 = 0.037, 0.033 and 0.087) and for e′ velocity negatively. In patients with S/D ratio <1, septal, lateral, average E/a′ ratio, average E/e ratio, LA vol index (p<.001) and TR velocity (p<.05) were significantly higher compared to patients with S/D ratio ≥1. No significant difference was seen in e′ velocity. The septal, lateral and average E/a′ ratio were significantly higher in patients with S/D ratio <1 regardless a normal or impaired diastolic function according to the ASE/EACVI guidelines (p<.001). The ASE/EACVI algorithm detected 21 patients with S/D ratio <1 compared to 28 patients using average E/a′ ratio with cut-off >14. Conclusion: E/a′ ratio might be a useful new diastolic parameter in patients with a normal ejection fraction as it is more closely related to the S/D ratio than the established ASE/EACVI diastolic parameters.