Validation of Established Standard Values for the Correlation of E/e’ Ratio and Left Ventricular Diastolic Pressure in a Study of 190 Patients with Dyspnea– What are the Main Factors for the Observed Discrepancies?

Abstract

Aim: In the past, Mitral E/e' ratio has been recommended for detecting elevated left ventricular filling pressures. However, more recently, gender specific differences in E/e´ ratios have been demonstrated. The aim of this prospective study was to validate the established standard values for the correlation of E/e´ ratio and left ventricular end diastolic pressure LVEDP in 190 consecutive patients with dyspnea in terms of age and gender differences. Methods and results: 190 patients had sufficient echogenicity to allow complete assessment of the Doppler and tissue Doppler parameters. Overall, there was only a weak significant correlation between E/e´ ratio and LVEDP pre laevo cardiography (R=0.24, P=0.006). In patients with ejection fraction (EF) > 50% there was no significant correlation. Female patients had higher baseline E/e' ratios than male patients. An E/e' ratio > 15 for predicting an elevated LVEDP was only significant in male but not in female patients. E/e´ ratio increases progressively with age and is remarkable higher in women than in men. Irrespective of gender, a stratification of E/e' ratio < 8, 8-15 and > 15 did not allow prediction of LVEDP. Conclusions: Only male patients showed a significant correlation (R = 0.29, P = 0.012) between their E/e' and LVEDP with respect to difference in gender. Excessively high E/e´ ratios measured in women were less pathognomonic for diastolic dysfunction than in men.