title: Regional wall motion abnormality at the lateral wall disturbs correlations between tissue Doppler E/e' ratios and left ventricular diastolic performance parameters measured by invasive methods.
abstract: BACKGROUND
  The impact of regional wall motion abnormality (RWMA) on the accuracy of heart failure with preserved ejection fraction (HFpEF) diagnosis using the E/e' ratio, which is a non-invasive parameter of left ventricular diastolic performance, is unknown. The purpose of this study was to elucidate the impact of RWMA of the lateral wall (RWMAlat) on the correlation between E/e' and invasive parameters of left ventricular diastolic performance.
  
  
  METHODS
  Three hundred and eight consecutive patients undergoing tissue Doppler imaging and catheterization pressure examination were retrospectively analyzed. E/e' was calculated as the ratio of early diastolic transmitral flow velocity to mitral annular velocity at the lateral wall. Invasive parameters including left ventricular end-diastolic pressure (LVEDP) and isovolumetric relaxation time constant (τ) were assessed based on the left ventricular pressure study. Correlation coefficients between E/e' and these invasive parameters were analyzed and compared between cases with RWMAlat and without RWMA.
  
  
  RESULTS
  LVEDP and τ correlated well with E/e' for all 308 patients (r = 0.51 and r = 0.65, respectively). Sixty-two patients had RWMA; the remaining 246 did not have RWMAlat. We confirmed that the presence of RWMAlat weakens both the correlations between E/e' and LVEDP (r = 0.574 vs. r = 0.381), and E/e' and τ (r = 0.729 vs. r = 0.461).
  
  
  CONCLUSIONS
  Although E/e' correlates well with parameters of left ventricular diastolic performance assessed by invasive methods, the presence of RWMAlat worsens this correlation. In cases with RWMAlat, careful assessment is required for HFpEF diagnosis because the diagnostic value of the E/e' ratio could be decreased compared to patients without RWMAlat.
authors: Department of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193 Japan.
authors: Toshiharu
authors: T
authors: Fujii
authors: Koichiro
authors: K
authors: Yoshioka
authors: Masataka
authors: M
authors: Nakano
authors: Gaku
authors: G
authors: Nakazawa
authors: Mari
authors: M
authors: Amino
authors: Naoki
authors: N
authors: Masuda
authors: Norihiko
authors: N
authors: Shinozaki
authors: Shigetaka
authors: S
authors: Kanda
authors: Nobuhiko
authors: N
authors: Ogata
authors: Yoshiaki
authors: Y
authors: Deguchi
authors: Fuminobu
authors: F
authors: Yoshimachi
authors: Yuji
authors: Y
authors: Ikari
keywords: Diastolic phase of mitral annulus velocity; E/e′; Heart failure with normal left ventricular ejection fraction; Isovolumetric relaxation time constant; Left ventricular end-diastolic pressure; Tissue Doppler imaging