Key result
Baseline E/A abnormality (<0.8) was independently associated with a higher risk of developing concentric hypertrophy over 5 years (OR 4.14, 95% CI 1.80-9.20, P=0.009).
Why the study?
Although the E/A ratio has important diagnostic and prognostic implications, the causal link between abnormal E/A ratio and left ventricle remodeling remains unclear.
Does baseline E/A ratio abnormality predict the development of left ventricular remodeling in middle-aged and elderly women?
Cohort (n=869)
No
Does baseline E/A ratio abnormality predict the development of left ventricular remodeling in middle-aged and elderly women?
Odds Ratio: 4.14 (95% CI 1.8–9.2)
Absolute Event Rate: 6.38% vs 1.17%
p-value: p=0.009
Impaired left ventricular relaxation indicated by an E/A ratio < 0.8 precedes and predicts concentric hypertrophy in women.
E/A abnormality may flag higher concentric hypertrophy risk in women ≥45; hypothesis-generating and requires prospective validation before any practice change.
Background: Impaired left ventricular (LV) relaxation is indicative of grade I diastolic dysfunction, which is mainly assessed by late diastolic transmitral flow velocity (E/A ratio). Although the E/A ratio has important diagnostic and prognostic implications with cardiac outcomes, the causal link between abnormal E/A ratio and left ventricle remodeling (LV remodeling) remains unclear. Methods: A longitudinal analysis of 869 eligible women aged ≥45 years, who had received echocardiography scans as well as 5-year follow-up assessments between 2015 and 2020. Women with pre-existing cardiac abnormalities including grade II/III diastolic dysfunction as diagnosed by echocardiography, or structural heart disease were excluded. E/A abnormality was defined as baseline E/A ratio <0.8. The classification of LV remodeling was based on the measurements of left ventricular mass index (LVMI) and relative wall thickness (RWT). Logistic and linear regression models were used. Results: Among the 869 women (60.71±10.01 years), 164 (18.9%) had developed LV remodeling after the 5-year follow-up. The proportion of women with E/A abnormality versus non-abnormality was also significantly different (27.13% vs 16.59%, P=0.007). Multivariable-adjusted regression models showed that E/A abnormality (OR: 4.14, 95%Cl:1.80-9.20, P=0.009) was significantly associated with higher risk of concentric hypertrophy (CH) after follow-up. No such association was found in either concentric remodeling (CR) or eccentric hypertrophy (EH). Higher baseline E/A ratio was correlated with lower ΔRWT during the 5-year follow-up (β=-0.006 m/s, 95% CI: -0.012 to -0.002, P=0.025), which was independent of demographics and biological factors. Conclusion: E/A abnormality is associated with a higher risk of CH. Higher baseline E/A ratio may be associated with decreased relative changes in RWT.
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Wu et al. (2023) conducted a cohort in Middle-aged and elderly women without baseline structural heart disease (n=869). E/A ratio abnormality (baseline E/A < 0.8) vs. Normal baseline E/A ratio (0.8 ≤ E/A < 1.5) was evaluated on Incidence of concentric hypertrophy (CH) at 5 years (OR 4.14, 95% CI 1.80-9.20, p=0.009). Baseline E/A abnormality (<0.8) was independently associated with a higher risk of developing concentric hypertrophy over 5 years (OR 4.14, 95% CI 1.80-9.20, P=0.009).
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