Is mitral E/E' ratio a reliable predictor of left ventricular diastolic pressures in patients without heart failure?

Aim: Conflicting evidence exists as to whether the mitral E/E′ ratio can be a reliable predictor of the left ventricular enddiastolic pressure (LVEDP). Our aim was to assess the value of the mitral E/E′ ratio for the estimation of left ventricular diastolic pressures (LVDP) in patients without heart failure (HF). Methods and results: Echo-Doppler examination and left heart catheterization were carried out in 100 consecutive patients to assess the correlation between echo-Doppler parameters and the LVDP. The E/A ratio showed the best correlation with the pre-a LVDP and the LVEDP, whereas septal and mean E/E′ ratios were significantly correlated with pre-a LVDP but not with the LVEDP. No difference in the echo-Doppler parameters was found between patients with normal and elevated LVEDP. Mitral E/E′ ratio was significantly higher in patients with an ejection fraction (EF) <50% compared with those with the EF ≥50% and in patients with a dilated left ventricular (LV) compared with those with a normal LV. No significant difference in mean LVEDP was found among the three groups with E/E′ ratios of <8, 8-15, and >15. The best cut-off values identified by receiver operating characteristic curve analysis for septal, lateral, and mean E/E′ had sensitivities of 53, 68, and 54% and specificities of 66, 51, and 69% for identifying a >15 mmHg LVEDP. Conclusion: In patients without HF mitral E/E′ ratio is influenced by EF and LV volumes and is better correlated with the pre-a LVDP than with the LVEDP. The suboptimal sensitivity and specificity of E/E′ for predicting increased LVDP suggest that the mitral E/E′ ratio is of limited clinical value in patients without HF. Published on behalf of the European Society of Cardiology. All rights reserved