Echocardiographic diastolic indices and the ambulatory heart rate profile in preserved ejection fraction: implications for pre-exercise assessment

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Preserved left ventricular ejection fraction (LVEF ≥50%) undergoing cardiac evaluation (n=300). Intervention: Echocardiographic diastolic and structural indices (E/A ratio ≥1, LA diameter, PASP) vs. E/A ratio <1. Primary outcome: 24-hour ambulatory heart rate range (maximum minus minimum HR) (B 12.62 (standardized β 0.261) for E/A ratio; B -7.30 (standardized β -0.185) for LA diameter, 95% CI 7.50-17.74, p=<0.001).

Q: What does this research mean for the field?

In adults with preserved ejection fraction, a higher mitral E/A ratio and a smaller left atrial diameter are independently associated with a wider 24-hour ambulatory heart rate range. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To examine the relationship between echocardiographic diastolic and structural indices and the 24-hour ambulatory heart rate profile in adults with preserved left ventricular ejection fraction.

Ayşe Melike Gerek; Sefa Tatar

doi:10.47582/jompac.1999789

October 25, 2026Journal of Medicine and Palliative CareOpen Access

Echocardiographic diastolic indices and the ambulatory heart rate profile in preserved ejection fraction: implications for pre-exercise assessment

View Full Paper

Ask AI

Bookmark

Share

Key result

Mitral E/A ratio (B=12.62, p<0.001) and left atrial diameter (B=-7.30, p=0.001) independently correlated with the 24-hour ambulatory heart rate range in adults with preserved ejection fraction.

Why the study?

In patients with preserved ejection fraction, the relationship between routinely available echocardiographic diastolic and structural indices and the 24 h ambulatory heart rate profile is not well defined.

Are routinely available echocardiographic diastolic and structural indices (E/A ratio, LA diameter, and PASP) associated with the 24-hour ambulatory heart rate range in adults with preserved ejection fraction?

Key Points

To examine the relationship between echocardiographic diastolic and structural indices and the 24-hour ambulatory heart rate profile in adults with preserved left ventricular ejection fraction.
Single-center retrospective study analyzing 300 adults with preserved left ventricular ejection fraction (LVEF ≥50%) who completed transthoracic echocardiography and 24 h Holter monitoring.
Assessed echocardiographic variables (mitral inflow E/A ratio, left atrial diameter, and pulmonary artery systolic pressure) against ambulatory heart rate metrics (maximum, minimum, mean, and dynamic range).
Compared groups categorized by E/A pattern (<1 vs. ≥1) and evaluated independent correlates using Spearman correlations and multivariable linear regression adjusting for age, gender, atrial fibrillation, and rate-limiting drugs.
Patients with E/A ≥1 had a significantly wider heart rate range (median 68 vs. 55 bpm; p<0.001) and higher maximum heart rate (121.3±22.3 vs. 112.5±18.1 bpm; p<0.001) than those with E/A <1, with no significant differences in mean or minimum heart rate (p=0.267 and p=0.078).
Heart rate range correlated positively with E/A ratio (r=0.33; p<0.001) and negatively with left atrial diameter (r=-0.28; p<0.001) and pulmonary artery systolic pressure (r=-0.21; p<0.001).
In multivariable linear regression, higher E/A ratio (B=12.62, 95% CI 7.50 to 17.74; standardized β=0.261; p<0.001) and smaller left atrial diameter (B=-7.30, 95% CI -11.69 to -2.90; standardized β=-0.185; p=0.001) independently predicted a wider heart rate range (model R²=0.211).

Study Design

Type

Cohort (n=300)

Multicenter

No

Structured PICO

Are routinely available echocardiographic diastolic and structural indices (E/A ratio, LA diameter, and PASP) associated with the 24-hour ambulatory heart rate range in adults with preserved ejection fraction?

P

Population

300 adult outpatients (mean age 53.9 years, 63.0% female) with preserved ejection fraction (LVEF ≥50%) undergoing both transthoracic echocardiography and 24-hour Holter monitoring within 90 days.

E

Exposure

Echocardiographic diastolic and structural indices assessment, specifically early-to-late diastolic mitral inflow velocity ratio (E/A; evaluated continuously and as E/A ≥1 vs E/A <1), left atrial (LA) diameter, and pulmonary artery systolic pressure (PASP).

O

Outcome

24-hour ambulatory (Holter) heart rate (HR) range (defined as maximum HR minus minimum HR based on one-minute averaged HR values over 24 hours)surrogate

Main Result

Effect estimate: B 12.62 (standardized β 0.261) for E/A ratio; B -7.30 (standardized β -0.185) for LA diameter (95% CI 7.50-17.74)

Absolute Event Rate: 68% vs 55%

p-value: p=<0.001

In outpatients with preserved ejection fraction, routine echocardiographic mitral E/A ratio and left atrial diameter are independently associated with the 24-hour ambulatory heart rate range, offering potential hypothesis-generating insights into daily dynamic chronotropic behavior when cardiopulmonary exercise testing is unavailable.

Limitations

Retrospective, cross-sectional, and single-center design prevents causal inference and limits generalizability.
Absence of tissue Doppler (e') data prevents reliable exclusion of pseudonormal filling at the individual patient level.
Left atrial size was assessed using linear diameter rather than the recommended left atrial volume index.
Rate-limiting medication was recorded only as present or absent without dose or adherence data.
Ambulatory heart rate range is not a validated substitute for chronotropic reserve measured during cardiopulmonary exercise testing.
Single-center, retrospective chart review design
The ambulatory HR range is a descriptive index of daily HR behavior and not a validated substitute for chronotropic reserve derived from cardiopulmonary exercise testing (CPET)
LA diameter does not replace LA volume index as a contemporary marker of diastolic burden
Without tissue Doppler (e') data, pseudonormal filling cannot be reliably excluded at the individual patient level in the E/A ≥1 group
Unstable multivariable estimate for atrial fibrillation due to small sample size (only 11 patients with AF)

Implication

E/A ratio and LA diameter were associated with heart rate range; hypothesis-generating for risk stratification in preserved EF and requires prospective validation.

Abstract

Aims: In patients with preserved ejection fraction, the relationship between routinely available echocardiographic indices and the ambulatory heart rate (HR) profile is not well defined. This study aimed to examine the association between echocardiographic diastolic and structural indices and the 24 h ambulatory (Holter) HR profile, with relevance to pre-exercise assessment.Methods: This single-center, retrospective study evaluated 300 adults with preserved left ventricular ejection fraction (LVEF ≥50%) who underwent both transthoracic echocardiography and 24 h Holter monitoring. The early-to-late diastolic mitral inflow velocity ratio (E/A), left atrial (LA) diameter, and pulmonary artery systolic pressure (PASP) were analyzed against the maximum, minimum, and mean HR and the HR range (maximum minus minimum), a descriptive index of daily HR behavior rather than a measure of exercise chronotropic reserve. Group comparison by E/A pattern, Spearman correlation, and multivariable linear regression were performed.Results: The HR range was higher in the E/A ≥1 group than in the E/A

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Gerek et al. (2026) conducted a cohort in Preserved left ventricular ejection fraction (LVEF ≥50%) undergoing cardiac evaluation (n=300). Echocardiographic diastolic and structural indices (E/A ratio ≥1, LA diameter, PASP) vs. E/A ratio <1 was evaluated on 24-hour ambulatory heart rate range (maximum minus minimum HR) (B 12.62 (standardized β 0.261) for E/A ratio; B -7.30 (standardized β -0.185) for LA diameter, 95% CI 7.50-17.74, p=<0.001). Mitral E/A ratio (B=12.62, p<0.001) and left atrial diameter (B=-7.30, p=0.001) independently correlated with the 24-hour ambulatory heart rate range in adults with preserved ejection fraction.

synapsesocial.com/papers/6ae7d421edffb49629410452 https://doi.org/10.47582/jompac.1999789

View Full Paper

Ask AI

Bookmark

Share

Echocardiographic diastolic indices and the ambulatory heart rate profile in preserved ejection fraction: implications for pre-exercise assessment

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Echocardiographic diastolic indices and the ambulatory heart rate profile in preserved ejection fraction: implications for pre-exercise assessment

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading