Key result
An E/e ratio >15 showed low sensitivity (32%) for detecting elevated left ventricular filling pressure, whereas right ventricular pressure >30 mmHg demonstrated high sensitivity (94%) and NPV (97%).
Why the study?
Do E/e > 15 and RVp > 30 mmHg accurately identify Doppler-assumed elevation of left ventricular filling pressure in patients with acute coronary syndromes?
Case-Control (n=184)
Do E/e > 15 and RVp > 30 mmHg accurately identify Doppler-assumed elevation of left ventricular filling pressure in patients with acute coronary syndromes?
The low sensitivity of E/e > 15 limits its utility as a single variable for detecting elevated LV filling pressure in ACS, whereas RVp > 30 mmHg offers high sensitivity and negative predictive value.
Caution against relying on E/e >15 alone in ACS; leaves open prospective validation of RVp >30 mmHg.
AIM: A ratio>15 between the early diastolic pulsed Doppler velocities of the mitral inflow (E) and the basal left ventricular (LV) tissue (e) has been demonstrated to predict an elevated LV filling pressure (FP). An elevated LVFP implies an elevated right ventricular pressure (RVp). In order to investigate the sensitivity of the E/e filling index, we compared E/e and RVp, in their ability to identify a Doppler-assumed elevation of LVFP. METHODS AND RESULTS: Application of pulsed Doppler international recommendations grouped 134 patients with acute coronary syndromes (ACS) and 50 age- and sex-matched controls, according to LV filling: normal; delayed relaxation; an isolated pathological mitral-pulmonary venous-A-wave-duration difference; pseudo normal; or a restrictive filling pattern. An E/e>15 and an RVp>30 mmHg showed the following (%) sensitivity (32/94), specificity (95/76), positive (68/59), and negative (80/97) predictive values of a Doppler-assumed elevation of LVFP, in terms of either a pseudo normal or a restrictive filling pattern. CONCLUSION: The low sensitivity of E/e to detect a Doppler-assumed elevation of LVFP could limit its clinical usefulness as a single variable, in ACS. The high sensitivity and negative predictive value of RVp support its use as an additional LV filling variable in these patients.
No takes yet. Share an insight, caveat, or question.
WALLENTINGURON et al. (2005) conducted a case-control in Acute coronary syndromes (ACS) (n=184). E/e filling index and right ventricular pressure was evaluated on Doppler-assumed elevation of left ventricular filling pressure (pseudo normal or restrictive filling pattern). An E/e ratio >15 showed low sensitivity (32%) for detecting elevated left ventricular filling pressure, whereas right ventricular pressure >30 mmHg demonstrated high sensitivity (94%) and NPV (97%).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: