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Comprehensive Overview: E/e’ in Clinical Management of Patients - Cardiology Consultation

This presentation provides a thorough analysis of E/e’ as a reliable method for tele-diastolic pressure evaluation and clinical patient management in cardiology practice. It covers topics such as LV filling pressure determination, assessment of LV relaxation kinetics, and the significance of Doppler flow parameters in diagnosing heart failure. The implications of E/e’ values on LV diastolic function and the correlation with various cardiac parameters are also discussed with supporting research references.

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Comprehensive Overview: E/e’ in Clinical Management of Patients - Cardiology Consultation

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  1. IL CALCOLO DEL RAPPORTO E/e’ VA ROUTINARIAMENTE INSERITO IN OGNI REPORT IN QUANTO METODO AFFIDABILE PER IL RILIEVO DELLA PRESSIONE TELEDIASTOLICA E LA GESTIONE CLINICA DEL PAZIENTE? Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory Sheikh Khalifa Medical City – Abu Dhabi, U.A.E.

  2. TO THE POINT • What is E/e’? • Determination of LV filling pressure • Evaluation of pts (with HF) E/e’ and LV filling pressure l December 20, 2019 l 2

  3. MITRAL INFLOW VELOCITY E wave • LV relaxation kinetics • LA pressure E/e’ and LV filling pressure l December 20, 2019 l 3

  4. PHYSIOLOGY OF LV FILLING Little and Oh. Circulation 2009;120:802-809. E/e’ and LV filling pressure l December 20, 2019 l 4

  5. RESTRICTIVE LV FILLING Masutani et al. Circulation 2008;117:1550-1554. Presentation Title l December 20, 2019 l 5

  6. DOPPLER FLOW PARAMETERS AND LVDP Variable r E/A 0.59 DT 0.48 PVs/PVd 0.31 Pva-Mva 0.29 ∆ E/A 0.43 Ommen et al. Circulation 2000;102:1788-1794. E/e’ and LV filling pressure l December 20, 2019 l 6

  7. DOPPLER FLOW PARAMETERS AND LVDP Variable r EF >50% EF <50% E/A 0.59 0.25 0.46 DT 0.48 0.17 0.60 PVs/PVd 0.31 0.03 0.23 Pva-Mva 0.29 0.39 0.12 ∆ E/A 0.43 0.36 0.30 Ommen et al. Circulation 2000;102:1788-1794. E/e’ and LV filling pressure l December 20, 2019 l 7

  8. DOPPLER FLOW PARAMETERS AND LVDP 100 80 60 Correctly classified, % 40 20 0 PVs/PVd E/A DT ∆ E/A Pva-MVa Ommen et al. Circulation 2000;102:1788-1794. Presentation Title l December 20, 2019 l 8

  9. DOPPLER FLOW PARAMETERS AND LVDP 100 80 60 Correctly classified, % 40 20 0 PVs/PVd E/A DT ∆ E/A Pva-MVa Ommen et al. Circulation 2000;102:1788-1794. Presentation Title l December 20, 2019 l 9

  10. LV DIASTOLIC FUNCTION Mitral flow Doppler alone is not enough! E/e’ and LV filling pressure l December 20, 2019 l 10

  11. MITRAL ANNULAR VELOCITY e’ wave • LV relaxation kinetics E/e’ and LV filling pressure l December 20, 2019 l 11

  12. WHAT IS e’? • It behaves as an index of LV relaxation • Significant inverse correlation with tau • No change with preload alterations E/e’ and LV filling pressure l December 20, 2019 l 12

  13. WHY E/e’? • LV relaxation kinetics • LA pressure E e’ • LV relaxation kinetics E/e’ and LV filling pressure l December 20, 2019 l 14

  14. WHY E/e’? • LV relaxation kinetics • LA pressure E e’ • LV relaxation kinetics E/e’ and LV filling pressure l December 20, 2019 l 15

  15. RESTRICTIVE LV FILLING Masutani et al. Circulation 2008;117:1550-1554. Presentation Title l December 20, 2019 l 16

  16. DIASTOLIC MITRAL ANNULAR VELOCITY Normal Normal HF HF Hasegawa et al. J Am Coll Cardiol 2003;41;1590-7. E/e’ and LV filling pressure l December 20, 2019 l 18

  17. DIASTOLIC PARAMETERS AND TAU () E (ml/sec) Peak e’ (mm/sec) Hasegawa et al. J Am Coll Cardiol 2003;41;1590-7. E/e’ and LV filling pressure l December 20, 2019 l 19

  18. TO THE POINT E/e’ and LV filling pressure l December 20, 2019 l 20 What is E/e’ Determination of LV filling pressure Evaluation of pts with HF

  19. ASSESSMENT OF LV FILLING PRESSURE Ommen et al. Circulation 2000;102:1788-1794. E/e’ and LV filling pressure l December 20, 2019 l 21

  20. LV FILLING PRESSURE DEFINED BY E/e’ EF <50% EF >50% LVDP (mmHg) E/e’ <8 E/e’ >15 Ommen et al. Circulation 2000;102:1788-1794. E/e’ and LV filling pressure l December 20, 2019 l 22

  21. LV FILLING PRESSURE DEFINED BY E/e’ EF <50% EF >50% LVDP (mmHg) E/e’ 8÷15 Ommen et al. Circulation 2000;102:1788-1794. E/e’ and LV filling pressure l December 20, 2019 l 23

  22. LV FILLING PRESSURE DEFINED BY E/e’ Flow Doppler -ve PVa-Mva >30 ms Valsalva +ve >1 variable +ve X LVDP (mmHg) X X X X E/e’ 8÷15 Ommen et al. Circulation 2000;102:1788-1794. E/e’ and LV filling pressure l December 20, 2019 l 24

  23. LV FILLING PRESSURE DEFINED BY E/e’ PVa-Mva >30 ms Valsalva +ve >1 variable +ve X LVDP (mmHg) X X X X E/e’ 8÷15 Ommen et al. Circulation 2000;102:1788-1794. E/e’ and LV filling pressure l December 20, 2019 l 25

  24. LV FILLING PRESSURE DEFINED BY E/e’ Flow Doppler -ve LVDP (mmHg) X X E/e’ 8÷15 Ommen et al. Circulation 2000;102:1788-1794. E/e’ and LV filling pressure l December 20, 2019 l 26

  25. ONE SIZE FITS ALL! E/e’ and LV filling pressure l December 20, 2019 l 27

  26. CONSTRICTIVE PERICARDITIS PCWP 31 mmHg E/e’ 5 PCWP 18 mmHg E/e’ 17 Ha et al. Circulation 2001;104:976-978. E/e’ and LV filling pressure l December 20, 2019 l 29

  27. TO THE POINT E/e’ and LV filling pressure l December 20, 2019 l 30 What is E/e’ Determination of LV filling pressure Evaluation of pts with HF

  28. E/e’ and LV filling pressure l December 20, 2019 l 33

  29. Estimation of filling pressures in patients with normal EF E/e’ Sept E/e’ ≥15 or Lat E/e’ ≥12 or Aver E/e’ ≥13 E/e’ ≤8 (sept, lat, or average) E/e’ 9-14 LAV <34 ml/m2 Ar-A <0 ms Valsalva Δ E/A <0.5 PAS <30 mmHg IVRT/TE-e’ >2 LAV ≥34 ml/m2 Ar-A ≥30 ms Valsalva Δ E/A ≥0.5 PAS >35 mmHg IVRT/TE-e’ <2 Normal LAP Normal LAP LAP LAP E/e’ and LV filling pressure l December 20, 2019 l 34

  30. Estimation of filling pressures in patients with normal EF E/e’ and LV filling pressure l December 20, 2019 l 35

  31. E vel = 82 cm/sec e’ vel = 4 cm/sec E/e’ = 82/4 = 20.5 E/e’ and LV filling pressure l December 20, 2019 l 36

  32. Estimation of filling pressures in patients with normal EF E/e’ Sept E/e’ ≥15 or Lat E/e’ ≥12 or Aver E/e’ ≥13 E/e’ ≤8 (sept, lat, or average) E/e’ 9-14 LAV <34 ml/m2 Ar-A <0 ms Valsalva Δ E/A <0.5 PAS <30 mmHg IVRT/TE-e’ >2 LAV ≥34 ml/m2 Ar-A ≥30 ms Valsalva Δ E/A ≥0.5 PAS >35 mmHg IVRT/TE-e’ <2 Normal LAP Normal LAP LAP LAP E/e’ and LV filling pressure l December 20, 2019 l 37

  33. Estimation of filling pressures in patients with normal EF E/e’ Sept E/e’ ≥15 or Lat E/e’ ≥12 or Aver E/e’ ≥13 E/e’ ≤8 (sept, lat, or average) E/e’ 9-14 LAV <34 ml/m2 Ar-A <0 ms Valsalva Δ E/A <0.5 PAS <30 mmHg IVRT/TE-e’ >2 LAV ≥34 ml/m2 Ar-A ≥30 ms Valsalva Δ E/A ≥0.5 PAS >35 mmHg IVRT/TE-e’ <2 Normal LAP Normal LAP LAP LAP E/e’ and LV filling pressure l December 20, 2019 l 38

  34. Estimation of filling pressures in patients with normal EF E/e’ Sept E/e’ ≥15 or Lat E/e’ ≥12 or Aver E/e’ ≥13 E/e’ ≤8 (sept, lat, or average) E/e’ 9-14 LAV <34 ml/m2 Ar-A <0 ms Valsalva Δ E/A <0.5 PAS <30 mmHg IVRT/TE-e’ >2 LAV ≥34 ml/m2 Ar-A ≥30 ms Valsalva Δ E/A ≥0.5 PAS >35 mmHg IVRT/TE-e’ <2 Normal LAP Normal LAP LAP LAP E/e’ and LV filling pressure l December 20, 2019 l 39

  35. Estimation of filling pressures in patients with normal EF E/e’ Sept E/e’ ≥15 or Lat E/e’ ≥12 or Aver E/e’ ≥13 E/e’ ≤8 (sept, lat, or average) E/e’ 9-14 LAV <34 ml/m2 Ar-A <0 ms Valsalva Δ E/A <0.5 PAS <30 mmHg IVRT/TE-e’ >2 LAV ≥34 ml/m2 Ar-A ≥30 ms Valsalva Δ E/A ≥0.5 PAS >35 mmHg IVRT/TE-e’ <2 Normal LAP Normal LAP LAP LAP E/e’ and LV filling pressure l December 20, 2019 l 40

  36. Estimation of filling pressures in patients with depressed EF Mitral E/A E/A ’ ≥2, DT <150 ms E/A <1 and E ≤50 cm/sec E/A 1÷2, or E/A <1 and E >50 cm/sec E/e’ (average e’) <8 E/Vp <1.4 S/D >1 Ar-A <0 ms Valsalva Δ E/A <0.5 PAS <30 mmHg IVRT/TE-e’ >2 E/e’ (average e’) >15 E/Vp ≥2.5 S/D <1 Ar-A ≥30 ms Valsalva Δ E/A ≥0.5 PAS >35 mmHg IVRT/TE-e’ <2 E/e’ LAP LAP Normal LAP Normal LAP E/e’ and LV filling pressure l December 20, 2019 l 41

  37. E/e’ and LV filling pressure l December 20, 2019 l 42

  38. E/e’ and LV filling pressure l December 20, 2019 l 43

  39. VIZI PRIVATI, PUBBLICHE VIRTU’ E/e’ and LV filling pressure l December 20, 2019 l 44

  40. E/e’ and LV filling pressure l December 20, 2019 l 45

  41. E/e’ and LV filling pressure l December 20, 2019 l 46

  42. E/e’ and LV filling pressure l December 20, 2019 l 47

  43. SI FA, MA NON SI DICE … Dini FL et al. Eur J Echocardiogr 2010;11;703-710. E/e’ and LV filling pressure l December 20, 2019 l 48

  44. E/e’ and LV filling pressure l December 20, 2019 l 49

  45. IL CALCOLO DEL RAPPORTO E/e’ VA ROUTINARIAMENTE INSERITO IN OGNI REPORT IN QUANTO METODO AFFIDABILE PER IL RILIEVO DELLA PRESSIONE TELEDIASTOLICA E LA GESTIONE CLINICA DEL PAZIENTE? Pro: Alessandro Salustri Contro: Maurizio Galderisi Moderatori: Alfredo Zuppiroli Maurizio Galderisi Presentation Title l December 20, 2019 l 50

  46. E/e’ and LV filling pressure l December 20, 2019 l 51

  47. E/e’ and LV filling pressure l December 20, 2019 l 52

  48. Presentation Title l December 20, 2019 l 53

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