title: What Is the Evidence That the Tissue Doppler Index E/e' Reflects Left Ventricular Filling Pressure Changes After Exercise or Pharmacological Intervention for Evaluating Diastolic Function? A Systematic Review.
abstract: BACKGROUND
  Noninvasive echocardiographic tissue Doppler assessment (E/e') in response to exercise or pharmacological intervention has been proposed as a useful parameter to assess left ventricular (LV) filling pressure (LVFP) and LV diastolic dysfunction. However, the evidence for it is not well summarized.
  
  
  RESULTS
  Clinical studies that evaluated invasive LVFP changes in response to exercise/other interventions and echocardiographic E/e' were identified from PubMed, Scopus, Embase, and Cochrane Library databases. We grouped and evaluated studies that included patients with preserved LV ejection fraction (LVEF), patients with mixed/reduced LVEF, and patients with specific cardiac conditions. Overall, we found 28 studies with 9 studies for preserved LVEF, which was our primary interest. Studies had differing methodologies with limited data sets, which precluded quantitative meta-analysis. We therefore descriptively summarized our findings. Only 2 small studies (N=12 and 10) directly or indirectly support use of E/e' for assessing LVFP changes in preserved LVEF. In 7 other studies (cumulative N=429) of preserved LVEF, E/e' was not useful for assessing LVFP changes. For mixed/reduced LVEF groups or specific cardiac conditions, results similar to preserved LVEF were found.
  
  
  CONCLUSIONS
  We find that there is insufficient evidence that E/e' can reliably assess LVFP changes in response to exercise or other interventions. We suggest that well-designed prospective studies should be conducted for further evaluation.
authors.affiliation: Department of Medicine, University of Alabama at Birmingham, AL.
authors.forename: Oleg F
authors.initials: OF
authors.lastname: Sharifov
authors.affiliation: Department of Medicine, University of Alabama at Birmingham, AL hgupta@cvapc.com.|VA Medical Center, Birmingham, AL.|Cardiovascular Associates of the Southeast, Birmingham, AL.
authors.forename: Himanshu
authors.initials: H
authors.lastname: Gupta
mesh_terms: D002317:Cardiovascular Agents / Q000627:therapeutic use*; D003971:Diastole; D015150:Echocardiography, Doppler / Q000379:methods*; D005081:Exercise Therapy / Q000379:methods*; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D013318:Stroke Volume / Q000502:physiology*; D017725:Ventricular Pressure / Q000502:physiology*
chemical_list: D002317:Cardiovascular Agents
keywords: Doppler echocardiography; E/e′; diastolic dysfunction echocardiography; diastolic heart failure; exercise echocardiography; left ventricular diastolic dysfunction; left ventricular diastolic function; left ventricular filling pressure