Mishra et al used echocardiographic findings at the mitral valve to identify patients with coronary artery disease who are at risk for heart failure. The authors are from the VA Medical Center San Francisco, University of California at San Francisco and Weill Cornell Medical College and participated in the Heart and Soul Study.
Parameters:
(1) mitral E: peak early filling velocity in cm/s
(2) mitral A: peak velocity at atrial contraction
(3) deceleration time (DT) of the early mitral inflow (E) = time from peak E wave velocity to 0 in milliseconds = 0.5 * (duration of the E wave)
(4) mitral peak E-wave velocity (pE)
E to A ratio =
= (E) / (A)
DT to pE =
= DT/pE
E/A Ratio
Interpretation
Diastolic Dysfunction (Redfield et al)
<= 0.75
impaired relaxation
mild dysfunction
0.76 to 1.49
normal or pseudo-normal
normal or moderate dysfunction
>= 1.50
restrictive
severe dysfunction
where:
• Redfield et al give DT > 140 ms as normal. With severe diastolic dysfunction the E wave velocity increases and DT decreases, so the DT/E ratio should decrease.
Predictors of heart failure and adverse cardiovascular events in a patient with CAD:
(1) E/A ratio >= 1.50
(2) E/A ratio from 0.76 to 1.49 AND DT/pE ratio <= 2.0 msec/(cm/sec)
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