E/a′ ratio is closely related to pulmonary vein flow profile in patients with normal ejection fraction

Figures & data

Figure 1. (A–J) The correlation between the S/D ratio and different tissue-Doppler parameters, their derivatives and the ASE/EACVI diastolic parameters.

Table 1. Characteristics and assessment of the left ventricular systolic and diastolic function in the study population stratified for S/D ratio ≥1 or <1.

	S/D ratio ≥ 1	S/D ratio <1	p Value
Patients (n)	250	43
Age (yrs)	64.3 ± 12.1	67.9 ± 14.0	ns
Male	123 (49)	24 (56)	ns
Smokers	29 (12)	4 (20)	ns
Hypertension	50 (20)	4 (20)	ns
Diabetes	24 (10)	6 (30)	ns
Previous AMI	35 (14)	2 (10)	ns
Previous CABG	13 (5)	2 (10)	ns
Previous PCI	12 (5)	1 (5)	ns
Left ventricle
Septal wall (mm)	11.4 ± 2.0	12.1 ± 2.2	.052
Posterior wall (mm)	10.8 ± 1.9	11.0 ± 2.2	.528
LVEDD (mm)	45.4 ± 5.9	48.5 ± 4.9	.001
LVESD (mm)	28.8 ± 5.6	32.2 ± 4.9	<.001
Ejection fraction (%)	58.7 ± 4.0	58.6 ± 4.4	.847
Mitral flow
E-wave (m/s)	0.70 ± 0.20	1.00 ± 0.20	<.001
A-wave (m/s)	0.80 ± 0.20	0.60 ± 0.20	<.001
E/A ratio	1.00 ± 0.30	1.60 ± 0.40	<.001
Deceleration time (ms)	238.7 ± 61.8	187.9 ± 41.1	<.001
Right ventricle
TAM	21.1 ± 3.8	19.6 ± 5.0	.024
Pulmonary artery
Systolic pressure (mmHg)	29.8 ± 11.1	35.0 ± 11.8	.012
S/D ratio	1.47 ± 0.34	0.72 ± 0.16	0.001

Continuous data as mean ± SD, or n(%). LVEDD: LV end-diastolic dimensions; LVESD: LV end-systolic dimensions; S/D ratio: systolic/diastolic pulmonary blood flow.

Table 2. Different tissue-Doppler and their derivatives correlation to S/D ratio ≥1 or <1 compared to the criteria in the ASE/EACVI guidelines in all patients.

	EF >50%		p Value
All patients (n = 293)	S/D ≥ 1 (n = 250)	S/D < 1 (n = 43)
Septal a′ velocity (cm/s)	8.8 ± 2.1	6.0 ± 2.4	<.001
Lateral a′ velocity (cm/s)	9.3 ± 2.5	5.9 ± 2.6	<.001
Average a′ velocity (cm/s)	9.0 ± 2.0	6.0 ± 2.2	<.001
Septal E/a′ ratio	9.1 ± 4.1	20.2 ± 11.5	<.001
Lateral E/a′ ratio	8.7 ± 3.7	20.2 ± 10.1	<.001
Average E/a′ ratio	8.8 ± 3.5	19.5 ± 9.8	<.001
ASE/EACVI criteria
average E/e′ ratio	10.0 ± 3.8	13.3 ± 5.1	<.001
septal e′ velocity (cm/s)	6.8 ± 2.1	6.8 ± 2.4	.843
lateral e′ velocity (cm/s)	9.2 ± 2.8	9.4 ± 2.6	.684
LA vol index (ml/m^2)	29.4 ± 12.0	40.5 ± 14.1	<.001
TR velocity (m/s)	2.40 ± 0.50	2.60 ± 0.50	.019
Ejection fraction (%)	58.7 ± 4.0	58.6 ± 4.4	.847

Continuous data as mean ± SD.

E: diastolic early transmitral flow velocity; e′: diastolic early mitral annular velocity; E/e′: diastolic early transmitral flow velocity/early mitral annular velocity; a′: diastolic atrial mitral annular velocity; E/a′: diastolic early transmitral flow velocity/atrial mitral annular velocity; LA: left atrial; LV: left ventricular; S/D ratio: systolic/diastolic pulmonary blood flow; TR: tricuspid regurgitation.

Table 3. Different tissue-Doppler and their derivatives correlation to S/D ratio ≥1 or <1 in patients with a normal diastolic function or a diastolic dysfunction according to the ASE/EACVI guidelines.

Normal diastolic function (n = 231)	EF >50%		p Value
	S/D ≥ 1 (n = 209)	S/D < 1 (n = 22)
Septal a′ velocity (cm/s)	9.1 ± 2.0	7.0 ± 2.2	<.001
Lateral a′ velocity (cm/s)	9.3 ± 2.6	6.5 ± 2.4	<.001
Septal E/a′ ratio	8.6 ± 3.2	15.5 ± 8.6	<.001
Lateral E/a′ ratio	8.6 ± 3.6	16.0 ± 6.8	<.001
Average E/a′ ratio	8.4 ± 3.0	16.0 ± 6.9	<.001
Ejection fraction (%)	58.8 ± 4.0	58.1 ± 3.6	.436
Diastolic dysfunction (n = 62)	S/D  ≥ 1 (n = 41)	S/D <1 (n = 21)	p Value
Septal a′ velocity (cm/s)	7.4 ± 2.0	5.1 ± 2.2	<.001
Lateral a′ velocity (cm/s)	8.9 ± 2.2	5.3 ± 2.6	<.001
Septal E/a′ ratio	12.4 ± 6.6	24.9 ± 12.6	<.001
Lateral E/a′ ratio	9.9 ± 4.5	24.1 ± 11.2	<.001
Average E/a′ ratio	10.7 ± 4.9	23.8 ± 10.8	<.001
Ejection fraction (%)	58.5 ± 4.1	59.0 ± 5.1	.714

Continuous data as mean ± SD.