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

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. © 2017 the authors.