title: Is mitral E/E' ratio a reliable predictor of left ventricular diastolic pressures in patients without heart failure?
abstract: Aim Conflicting evidence exists as to whether the mitral E/E' ratio can be a reliable predictor of the left ventricular end-diastolic 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).
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Cardiology, IRCCS Fondazione Policlinico S.Matteo and University of Pavia School of Medicine, Piazzale Golgi 17, 27100 Pavia, Italy. m.previtali@smatteo.pv.it
authors.forename: Mario
authors.initials: M
authors.lastname: Previtali
authors.forename: Enrico
authors.initials: E
authors.lastname: Chieffo
authors.forename: Maurizio
authors.initials: M
authors.lastname: Ferrario
authors.forename: Catherine
authors.initials: C
authors.lastname: Klersy
mesh_terms: D006328:Cardiac Catheterization; D003971:Diastole / Q000502:physiology*; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D016277:Ventricular Function, Left / Q000502:physiology*; D017725:Ventricular Pressure / Q000502:physiology*