August 4, 2026Open Access
Noninvasive estimation of left ventricular filling pressure by e/e′ is a powerful predictor of survival after acute myocardial infarction
Key Result
An E/e' ratio >15 early after acute myocardial infarction was a powerful independent predictor of all-cause mortality (RR 4.8; 95% CI 2.1-10.8; p=0.0002).
Key Points
- This research aims to establish the prognostic significance of the e/e′ ratio after acute myocardial infarction.
- Echocardiograms obtained from 250 patients 1.6 days post myocardial infarction.
- Follow-up duration of median 13 months to determine all-cause mortality.
- 73 patients (29%) had an e/e′ >15, linked to increased mortality (log-rank statistic 21.3, p < 0.0001).
- e/e′ >15 was identified as the most powerful independent predictor of survival (risk ratio 4.8, 95% CI 2.1 to 10.8, p = 0.0002).
- Inclusion of e/e′ >15 enhanced the prognostic utility beyond clinical variables and other echocardiographic indices (p = 0.001).
Study Design
Type
Cohort (n=250)
PICO
P
Population
250 unselected patients evaluated 1.6 days after admission for acute myocardial infarction, followed for a median of 13 months.
E
Exposure / Comparator
E/e' ratio >15 vs E/e' ratio ≤15
O
Primary Outcome
All-cause mortality — risk ratio 4.8 (2.1 to 10.8), p=0.0002
Main Result
Relative Risk: 4.8 (95% CI 2.1–10.8)
p-value: p=0.0002
Abstract
OBJECTIVES: The aim of this study was to assess the prognostic value of a noninvasive measure of left ventricular diastolic pressure (LVDP) early after acute myocardial infarction (MI). BACKGROUND: The early diastolic velocity of the mitral valve annulus (e') reflects the rate of myocardial relaxation. When combined with measurement of the early transmitral flow velocity (E), the resultant ratio (E/e') correlates well with mean LVDP. In particular, an E/e' ratio >15 is an excellent predictor of an elevated mean LVDP. We hypothesized that an E/e' ratio >15 would predict poorer survival after acute MI. METHODS: Echocardiograms were obtained in 250 unselected patients 1.6 days after admission for MI. Patients were followed for a median of 13 months. The end point was all-cause mortality. RESULTS: Seventy-three patients (29%) had an E/e' >15. This was associated with excess mortality (log-rank statistic 21.3, p 15 improved the prognostic utility of a model containing clinical variables and conventional echocardiographic indexes of left ventricular systolic and diastolic function (p = 0.001). CONCLUSIONS: E/e' is a powerful predictor of survival after acute MI. An E/e' ratio >15 is superior, in this respect, to other clinical or echocardiographic features. Furthermore, it provides prognostic information incremental to these parameters.