Significant beat-to-beat variability of E/e’ irrespective of respiration

Christer Grönlund, Amanda Albano, Sandra Gustavsson, Urban Wiklund, Michael Henein, Per Lindqvist


The E/e’ ratio is commonly used in Doppler echocardiographic examinations to estimate the pulmonary capillary wedge
pressure. The rationale of using this ratio is to combine left ventricular (LV) filling (E) and relaxation (e’) velocities to indirectly
assess left atrial pressure. However, the accuracy of this index has recently been questioned, particularly in patients with
controlled heart failure1. Likewise, the potential beat-to-beat variability of such measurements remains undetermined.
The cardiovascular system is subject to several oscillations with the potential of influencing LV function and its intra-cavitary
pressures, hence measurements of its filling and relaxation velocities. The aim of this pilot study was to assess the beatto-
beat variability of the E/e’ ratio in one minute long examination in healthy subjects, and patients with various severity of
amyloid heart disease.
The results show that despite critical application of the standard echocardiographic recording recommendations, E/e’ beatto-
beat variability was 36 % (22 to 50%) in healthy subjects and 17 % (11-26%) in patients, and where the most severe
amyloid heart disease had the least variability. Thus, clinical use of a single or few cardiac beats might not necessarily reflect
an accurate ratio between the two velocities, and hence casts doubt over their diagnostic value.

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