The usefulness of combined assessment of E/E′ ratio and transmitral flow pattern to interpret cardiac condition

BACKGROUND: High mitral inflow early (E) velocity to tissue Doppler E' ratio (E/E') and an E to late diastolic filling velocity ratio (E/A) are used to evaluate left ventricular (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 1,266 patients who underwent echocardiography to assess cardiac function. 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: High E/E' with both high and low E/A groups showed lower LV ejection fraction and higher LV mass index compared to low E/E' with both high and low E/A groups. High E/E' with both high and low E/A groups showed slower E' velocity and larger left atrial volume index compared to low E/E' with both high and low E/A groups, but high E/E' with low E/A group exhibited smaller left atrial volume index and higher pulmonary venous systolic to diastolic peak velocity ratio compared to high E/E' with high E/A group. Moreover, high E/E' with low E/A group displayed lower tricuspid regurgitant pressure gradient than the high E/E' with high E/A group. Conclusion: Even in the situation of high E/E', low E/A condition indicated lower LV filling pressure and controlled fluid retention.