What Is the Evidence That the Tissue Doppler Index E/e' Reflects Left Ventricular Filling Pressure Changes After Exercise or Pharmacological Intervention for Evaluating Diastolic Function? A Systematic Review

Abstract

Background: Noninvasive echocardiographic tissue Doppler assessment (E/e') in response to exercise or pharmacological intervention has been proposed as a useful parameter to assess left ventricular (LV) filling pressure (LVFP) and LV diastolic dysfunction. However, the evidence for it is not well summarized.

Methods and results: Clinical studies that evaluated invasive LVFP changes in response to exercise/other interventions and echocardiographic E/e' were identified from PubMed, Scopus, Embase, and Cochrane Library databases. We grouped and evaluated studies that included patients with preserved LV ejection fraction (LVEF), patients with mixed/reduced LVEF, and patients with specific cardiac conditions. Overall, we found 28 studies with 9 studies for preserved LVEF, which was our primary interest. Studies had differing methodologies with limited data sets, which precluded quantitative meta-analysis. We therefore descriptively summarized our findings. Only 2 small studies (N=12 and 10) directly or indirectly support use of E/e' for assessing LVFP changes in preserved LVEF. In 7 other studies (cumulative N=429) of preserved LVEF, E/e' was not useful for assessing LVFP changes. For mixed/reduced LVEF groups or specific cardiac conditions, results similar to preserved LVEF were found.

Conclusions: We find that there is insufficient evidence that E/e' can reliably assess LVFP changes in response to exercise or other interventions. We suggest that well-designed prospective studies should be conducted for further evaluation.

Keywords: Doppler echocardiography; E/e′; diastolic dysfunction echocardiography; diastolic heart failure; exercise echocardiography; left ventricular diastolic dysfunction; left ventricular diastolic function; left ventricular filling pressure.

Figure 1

Summary of the literature search. Studies that include data for patients with preserved LVEF (LVEF ≥50%) were our primary interest. Other studies that include data for patients with mixed or reduced LVEF (LVEF <50%) and patients with specific cardiac conditions were our secondary interest. For this review, with studies identified during a comprehensive literature search for recent meta‐analysis, Sharifov et al20 were initially evaluated. An updated literature search was then performed based on specific search strings as described. One study included a data set for primary and secondary analysis. LVEF indicates left ventricular ejection fraction.