Aims: The peak transmitral velocity/peak mitral annular velocity (E/e′) ratio has been used as a left ventricular (LV) filling pressure (LVFP) correlate. However, the E/e′ and its changes with haemodynamic alterations have not always correlated with changes in LVFP's. We hypothesized that indexing E/e′ to a measure of LV filling volume may enhance the correlation with LVFP and LVFP changes. Methods and results: We summarized previously obtained haemodynamic and Doppler echo data in 137 dogs with coronary microsphere embolization induced-chronic LV dysfunction prior to and following haemodynamic induced alterations in LVFP's. E/e′ values were obtained as E∗tau where tau is the inverse logarithmic LV pressure decay. E∗tau was indexed to LV filling volume by dividing by the diastolic time velocity integral (DVI) and correlated with LV mean diastolic pressure (LVmDP). Similarly, the relationship of E/e′ and E/e′/DVI to LV pre A wave pressure was evaluated in 84 patients by invasive haemodynamics and Doppler echo. Combining data from all interventions, LVmDP correlated with E∗tau (r = 0.408) but more strongly with E∗tau/DVI (r = 0.667, z = 3.03, P = 0.0008). The change in LVmDP correlated with the change in E∗tau/DVI (r = 0.742) more strongly than E∗Tau (r = 0.187, Z = 4.01, P < 0.0001). In the patient cohort, E/e′ was modestly correlated with LV pre A wave pressure (r = 0.301) but more strongly correlated with E/e′/DVI (r = 0.636, z = 2.36, P = 0.0161). Conclusion: Indexing E to both LV relaxation and filling volume results in a more robust relation with LVFP's and with LVFP changes.

Increasing diastolic dysfunction (DD) grade is associated with increased heart failure (HF). Patients with preserved ejection fractions and grade 1 DD may have left atrial dilatation, e′ < 8 cm/sec, increased left ventricular (LV) mass, or variable E/e′ ratios. The aim of this study was to test the hypothesis that LV hypertrophy or E/e′ ratio > 8 may be associated with a greater incidence of HF. Methods Two hundred twelve patients with grade 1 DD and ejection fractions > 50% were retrospectively studied. Group 1 comprised 108 patients with E/A ratios < 0.8, without LV hypertrophy, e′ < 8 cm/sec, and E/e′ ratios < 8. Group 2 comprised 104 patients with LV hypertrophy or E/e′ ratios > 8. Patients with incident HF and valvular or coronary disease were excluded. Using two-dimensional Doppler echocardiography, LV and left atrial volumes and transmitral spectral and tissue Doppler were analyzed. Medical records were examined for laboratory data, HF admissions, and all-cause mortality from 2004 to 2012. Results Despite similar ejection fractions, patients in group 2 had greater LV and left atrial volumes, LV mass index values, and E/e′ ratios (P < .01 for all). HF incidence was greater in group 2 (30 vs 4, P < .001). Combined HF or all-cause mortality was greater in group 2 (46 vs 14, P < .001). Multivariate analysis revealed that HF was associated with E/e′ ratio (P < .0001), systolic blood pressure (P = .0123), and LV mass index (P = .042). Combined HF or all-cause mortality was associated with E/e′ ratio (P < .0001), LV mass index (P = .009), and lower calcium channel blocker use (P = .0011). Conclusions HF alone or HF and all-cause mortality were increased in patients with grade 1 DD in the presence of LV hypertrophy or elevated LV filling pressures.