title: Site-dependency of the E/e' ratio in predicting invasive left ventricular filling pressure in patients with suspected or ascertained coronary artery disease.
abstract: OBJECTIVE
  To test the accuracy of different mitral annular sites of the E/e' ratio in predicting invasive left ventricular filling pressure (LVFP) in patients hospitalized for coronary artery disease (CAD).
  
  
  METHODS
  Forty-one patients with suspected or ascertained chronic CAD underwent non-invasive estimation of LVFP the same day as coronary angiography combined with right catheterization for pulmonary capillary wedge pressure (PCWP) assessment. The ratio between E velocity and early diastolic velocity of the mitral annulus (e') was calculated as a surrogate of PWCP by (i) averaging septal and lateral e' (E/e'A2); (ii) averaging septal, lateral, inferior, anterior (E/e'A4); (iii) using the sole septal (E/e'S); or (iv) lateral annulus (E/e'L). Patients were divided in two groups according to the PCWP: 25 with the PCWP <18 mmHg and 16 with the PCWP ≥ 18 mmHg.
  
  
  RESULTS
  The two groups were comparable for gender, body mass index, blood pressure, heart rate (HR), E/A ratio, and deceleration time. The ejection fraction (EF) was lower and left atrial volume index (LAVi) greater (both P < 0.02) in patients with the PCWP ≥ 18 mmHg. They also exhibited higher E/e'S (P < 0.05), E/e'L (P < 0.0001), E/e'A2, and E/e'A4 (both P < 0.005) than patients with the PCWP <18 mmHg. In pooled groups, after adjusting for HR EF and LAVi, E/e'L (β = 0.42, P < 0.01), E/e'A2 (β = 0.32, P < 0.05), and E/e'A4 (β = 0.31, P < 0.05) were all independently associated with PWCP. E/e'L ≥ 16.2 predicted PCWP ≥18 mmHg with the highest diagnostic accuracy (AUC = 0.826), sensitivity (81.3%), and specificity (80%).
  
  
  CONCLUSIONS
  In patients with CAD, E/e'L is the most accurate parameter in predicting abnormally increased LVFP.
authors.affiliation: Laboratory of Echocardiography, Cardioangiology Unit with CCU, Department of Clinical and Experimental Medicine, Federico II University Hospital, Via S. Pansini 80131 Naples, Italy. mgalderi@unina.it
authors.forename: Maurizio
authors.initials: M
authors.lastname: Galderisi
authors.forename: Antonio
authors.initials: A
authors.lastname: Rapacciuolo
authors.forename: Roberta
authors.initials: R
authors.lastname: Esposito
authors.forename: Marco
authors.initials: M
authors.lastname: Versiero
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Schiano-Lomoriello
authors.forename: Ciro
authors.initials: C
authors.lastname: Santoro
authors.forename: Federico
authors.initials: F
authors.lastname: Piscione
authors.forename: Giovanni
authors.initials: G
authors.lastname: de Simone
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D015331:Cohort Studies; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D018618:Echocardiography, Doppler, Color / Q000379:methods; D018619:Echocardiography, Doppler, Pulsed / Q000379:methods*; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011669:Pulmonary Wedge Pressure / Q000502:physiology*; D012372:ROC Curve; D018570:Risk Assessment; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology*
keywords: Diastole; E/e′ ratio; Left ventricular filling pressure; Pulmonary capillary wedge pressure; Pulsed tissue Doppler