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Reference Ranges and Physiologic Variations of Left E/e' Ratio in Healthy Adults: Clinical and Echocardiographic
Antonello D'Andrea1, Olga Vriz2, Francesco Ferrara3
1Department of Cardiology, Luigi Vanvitelli University, Monaldi Hospital, AORN Ospedali dei Colli, Naples, Italy.
Insights
The transmitral E velocity to e' ratio increases with age in healthy adults. Age and gender-specific reference values are crucial for accurately assessing left ventricular diastolic function.
Area of Science:
- Cardiology
- Echocardiography
- Diastolic Function
Background:
- Transthoracic Doppler echocardiography is a common, noninvasive method for assessing diastolic ventricular function.
- Existing reference values for diastolic function are often limited and conflicting, especially regarding age and gender.
- Physiologic variations in left ventricular (LV) E/e' ratio require further investigation in healthy populations.
Purpose of the Study:
- To explore age- and gender-related variations in the LV E/e' ratio in healthy adults.
- To identify clinical and echocardiographic factors influencing the E/e' ratio.
Main Methods:
- Standard transthoracic echocardiographic examination was performed on 1168 healthy Caucasian adults.
- Data were collected between June 2007 and February 2014.
- Statistical analyses included ANOVA and stepwise multiple linear regression.
Main Results:
- The E/e' ratio showed a significant positive linear correlation with age across all age groups (P < 0.0001).
- Independent determinants of E/e' included age, LV mass, LV end-diastolic volume, and left atrial volume.
- The model explained 54% of the variance in the E/e' ratio (R² = 0.54, P < 0.0001).
Conclusions:
- The transmitral E velocity to e' ratio increases with age in healthy individuals, particularly those over 60.
- Age and gender differences necessitate tailored reference values for accurate LV diastolic function assessment.
- Using age- and gender-specific cutoffs is essential to avoid misclassification of normal individuals.
Background:
Transthoracic Doppler echocardiographic examination is commonly performed to define the diastolic ventricular function since it is widely available, noninvasive, and inexpensive with respect to other diagnostic imaging modalities. However, data regarding age- and gender-matched reference values are scanty and sometimes conflicting. This study aims to explore the physiologic variations of left ventricular (LV) E/e' ratio as assessed in a large cohort of healthy adults and to investigate clinical and echocardiographic correlates.
Methods:
From June 2007 to February 2014, 1168 healthy Caucasian adults (mean age 45.1 ± 15.6 years) performed standard echocardiographic examination (transthoracic echocardiogram).
Results:
E/e' constantly increases across all the age classes (P < 0.0001, analyses of variance both for males and females) with a strong statistically significant linear positive correlation with age. Stepwise multiple linear regression analysis identified age (P < 0.0001), LV mass (P < 0.001), LV end-diastolic volume (P < 0.01), and left atrial volume (P < 0.001) as the only independent determinants of E/e' ratio (model R2 = 0.54, P < 0.0001).
Conclusions:
In healthy subjects, transmitral E velocity to e' ratio changes in relation to the age: it increased with a statistically significant correlation in individuals older than 60 years. Hence, differences related to demographic and anthropometric measurements may potentially develop a misclassification of otherwise normal individuals when established on dichotomically suggested normal reference values. Our study can demonstrate that it is indispensable to apply specific cutoff related to the age and gender to properly assess LV diastolic function.