Clinical Relevance of the Spectral Tissue Doppler E/e’ Ratio in the Management of Patients with Atrial Fibrillation: a Comprehensive Review of the Literature.

Abstract

Atrial fibrillation is the most common cardiac rhythm disorder observed in clinical practice. It carries high morbidity and mortality rates, primarily related to heart failure, stroke and death. Validation of noninvasive markers in the diagnosis of heart failure with preserved ejection fraction and risk stratification is relevant in this clinical setting. The spectral tissue Dopplerderived E/e' ratio is a simple and reproducible index, which has been validated in noninvasive assessment of left ventricular diastolic pressures, regardless of rhythm. Septal E/e' >11 is a good predictor of invasively determined left ventricular diastolic pressure >15 mmHg in patients with atrial fibrillation. Several studies have validated the clinical relevance of abnormal values for E/e' at rest and during exercise in the diagnosis and risk stratification of heart failure with preserved ejection fraction in patients with atrial fibrillation. Increased E/e' value is associated with adverse outcome (death, left atrial appendage thrombus, stroke and heart failure) in patients with atrial fibrillation and predicts arrhythmia recurrence after cardioversion and catheter ablation. In conclusion, E/e' by spectral tissue Doppler is clinically relevant in the clinical management of any patients with atrial fibrillation referred for transthoracic Doppler echocardiography.

Case report: Diagnosis of apical hypertrophic cardiomyopathy that escaped clinical and echocardiographic investigations for twenty years: Reasons and clinical implications

“…Another important aspect of our case is the presence of significant LV diastolic dysfunction, that went unexplained and was wrongly attributed to hypertensive heart disease. The evaluation of diastolic dysfunction in Afib can be challenging ( 22 , 23 ). In our case unequivocal findings were present: firstly, dilation of the LA, that was the reason for the precocious Afib ( Figure 3 ) associated with an E/e' > 12 ( Figure 4 ) and secondarily, mild-moderate pulmonary hypertension (45 mmHg systolic) ( Figure 4 ).…”

Tissue Doppler indices of diastolic function as prognosticator in patients without heart failure in primary care

“…These patients were referred for a comprehensive cardiovascular evaluation by their general practitioners thus reflecting a primary care setting. The clinical question was to assess whether the available evidence reported in multiple, different experimental settings [1][2][3][4][19][20][21] may be duplicated in the heterogeneous clinical scenario encountered in every day clinical practice. During a midterm follow-up, e' and E/e' were both associated with clinical outcome in these patients, but only e' maintained its independent prognostic information in multivariable analysis.…”

“…Previous studies have shown that TDI indices of diastolic function provide information on outcome which is incremental to conventional 2D-DE in general population and multiple conditions [ [1][2][3][4]. Of particular interest, Kuznetsova et al [4], in 793 individuals from the general population (mean age 51 years), showed that e' velocity was a significant predictor of fatal and nonfatal cardiovascular and cardiac events.…”

“…Tissue Doppler imaging (TDI) indices of left ventricular (LV) diastolic function provide incremental prognostic information on cardiovascular mortality and morbidity in the general population and in several clinical scenarios [1][2][3][4]. Early mitral annular velocity assessed by TDI (e') is a reproducible and relatively loadindependent measure of LV myocardial relaxation, and is also determined by restoring forces and filling pressure.…”

Clinical relevance of tissue doppler‐derived e/e’ in patients with cardiovascular disease

“…4,5 A recent review has highlighted the usefulness of E/e' in the prediction of adverse outcome in patients with atrial fibrillation (heart failure, stroke, death, left atrial appendage thrombus, recurrence of arrhythmia). 6 Studies have reported the prognostic value of E/e' in the full spectrum of ischemic heart disease. [7][8][9] Other clinical studies have also offered evidence that E/e' predicts outcome in patients with hypertensive heart disease, hypertrophic cardiomyopathy, asymptomatic aortic stenosis, and even in critically ill patients.…”