Effects of age, gender, and left ventricular mass on septal mitral annulus velocity (E′) and the ratio of transmitral early peak velocity to E′ (E/E′)

doi:10.1016/j.amjcard.2005.01.021

The American Journal of Cardiology

Volume 95, Issue 8, 15 April 2005, Pages 1020-1023

https://doi.org/10.1016/j.amjcard.2005.01.021 Get rights and content

The ratio of the transmitral early peak velocity (E) evaluated by conventional Doppler imaging over early diastolic mitral annulus velocity (E′) evaluated by tissue Doppler imaging has been proposed as a noninvasive marker for left ventricular filling pressure. We evaluated 174 normal patients and 86 patients with hypertension and LV hypertrophy to assess the effects of age, gender, and left ventricular hypertrophy on E′ and E/E′. Age appeared to be the strongest determinant of E′ and E/E′, suggesting that in normal patients and in those with left ventricular hypertrophy, age-dependent cut-off values should be considered.

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Acknowledgment

Julie De Backer is a recipient of a BOF mandate at the University Gent, Belgium.

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There is limited data regarding longitudinal changes of diastolic function in the very old, who are at the highest risk for heart failure (HF).
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Mean age was 74 ± 4 years at visit 5 and 80 ± 4 at visit 7, 59% were women, and 24% were Black. At visit 5, mean e′_septal was 5.8 ± 1.4 cm/s, E/e′_septal 11.7 ± 3.5, and LAVI 24.3 ± 6.7 mL/m². Over a mean of 6.6 ± 0.8 years, e′_septal decreased by 0.6 ± 1.4 cm/s, E/e′_septal increased by 3.1 ± 4.4, and LAVI increased by 2.3 ± 6.4 mL/m². The proportion with 2 or more abnormal diastolic measures increased from 17% to 42% (P < 0.001). Compared with participants free of cardiovascular (CV) risk factors or diseases at visit 5 (n = 234), those with prevalent CV risk factors or diseases but without prevalent or incident HF (n = 2,150) demonstrated greater increases in E/e′_septal and LAVI. Increases of E/e′_septal and LAVI were both associated with the development of dyspnea between visits in analyses adjusted for CV risk factors.
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The echocardiographic parameter E/e’ has been associated with cardiovascular (CV) events. However, few studies have analyzed multiple associated CV outcomes using E/e’ in a diverse population of both inpatients and outpatients with and without cardiac diseases and risk factors.
Medical records of 75,393 patients without atrial fibrillation (AF) with first available E/e’ were retrieved from our hospital database. Patients with mitral valve disease were excluded, and the remainder were studied in protocol 1 (70,819 patients). Patients with hypertension, diabetes mellitus, hyperlipidemia, CV diseases, prior CV events, CV surgeries, and left ventricular ejection fraction <50% or missing left ventricular ejection fraction were further excluded, and the remaining patients were studied in protocol 2 (14,665 patients). The study outcomes are major adverse CV events (MACE), which included myocardial infarction (MI), AF, ischemic and hemorrhagic stroke (IHS), hospitalization for heart failure (HHF), and cardiac death. The primary outcomes were MACE and each of the MACE components.
At the end of maximal 5-year follow-up (median 22.18 months with interquartile range 7.20-49.08 months for MACE in protocol 1 and 23.46 months with interquartile range 8.15-49.02 months for MACE in protocol 2), compared with an E/e’ value of <8, an intermediate value of E/e’ 8 to 15 and a high value of E/e’ >15 were significantly associated with MACE, MI, AF, IHS, HHF, and cardiac death in protocol 1 (all P < .0001). In protocol 2, an intermediate E/e’ value of 8 to 15 and a high value of E/e’ >15 were significantly associated with MACE, MI, AF, IHS, HHF, and CV death (all P < .05), except an intermediate value E/e’ 8 to 15 was not associated with AF.
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The objective of this study was to determine short- and long-term excess mortality associated with diastolic echocardiographic measures (primarily E/e′ ratio) in patients with HF with reduced ejection fraction.
In patients with heart failure (HF), Doppler echocardiography diastolic alterations are frequently but not convincingly linked to survival. Consequently, they are not included in risk-score algorithms or substantially mentioned in HF guidelines.
Consecutive patients with HF Stage B to C, diagnosed between 2003 and 2011, with ejection fraction <50%, Doppler diastolic characterization, complete clinical evaluation, and estimated pulmonary pressure, were analyzed. Outcome measure was mortality under medical management.
The 12,421 eligible patients were 69 ± 14 years of age, 32% were women, 72% had Stage C HF, with ejection fraction 36 ± 10% and E/e′ ratio of 17 ± 9. During median follow-up 4.0 (1.1 to 7.0) years, 1-year and 5-year mortality were 17 ± 0.4% and 42 ± 0.5%. E/e′ ratio >20 was linked to elevated 1-year mortality (adjusted odds ratio: 1.45 [95% confidence interval (CI): 1.16 to 1.83]; p = 0.001). Long-term E/e′ ratios >20 and >14 to 20 were associated with reduced survival (adjusted hazard ratio: 1.21 [95% CI: 1.07 to 1.37]; p = 0.003, and adjusted hazard ratio: 1.15 [95% CI: 1.02 to 1.29]; p = 0.02), independent of all HF characteristics and in all patients’ subsets, including HF Stage B and Stage C. Guideline-based diastolic-grade algorithm also independently predicted mortality (p < 0.0001) but was definable less frequently (70%).
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Brief reportsEffects of age, gender, and left ventricular mass on septal mitral annulus velocity (E′) and the ratio of transmitral early peak velocity to E′ (E/E′)

Section snippets

Acknowledgment

J Am Coll Cardiol

J Am Soc Echocardiogr

J Am Coll Cardiol

J Am Coll Cardiol

J Am Soc Echocardiogr

J Am Coll Cardiol

Brief reports
Effects of age, gender, and left ventricular mass on septal mitral annulus velocity (E′) and the ratio of transmitral early peak velocity to E′ (E/E′)