Diagnostic accuracy of tissue Doppler index E/e' for evaluating left ventricular filling pressure and diastolic dysfunction/heart failure with preserved ejection fraction: A systematic review and meta-analysis

Background-tissue doppler index e/e' is used clinically and in multidisciplinary research for estimation of left ventricular filling pressure (lvfp) and diastolic dysfunction (dd)/heart failure with preserved ejection fraction (hfpef). its diagnostic accuracy is not well studied. methods and results-from the pubmed,scopus,embase,and cochrane databases,we identified 24 studies reporting e/e' and invasive lvfp in preserved ef (≥50%). in random-effects models,e/e' had poor to mediocre linear correlation with lvfp. summary sensitivity and specificity (with 95% cis) for the american society of echocardiography-recommended e/e' cutoffs (lateral,mean,and septal,respectively) to identify elevated lvfp was estimated by using hierarchical summary receiver operating characteristic analysis. summary sensitivity was 30% (9-48%),37% (13-61%),and 24% (6-46%),and summary specificity was 92% (82-100%),91% (80-99%),and 98% (92-100%). positive likelihood ratio (lr+) was <5 for lateral and mean e/e'. lr+ was slightly >10 for septal e/e' obtained from 4 studies (cumulative sample size <220). for excluding elevated lvfp,summary sensitivity for e/e' (lateral,mean,and septal,respectively) was 64% (38-86%),36% (3-74%),and 50% (14-81%),while summary specificity was 73% (54-89%),83% (49-100%),and 89% (66-100%). because of data set limitations,meaningful inference for identifying hfpef by using e/e' could not be drawn. with the use of quality assessment tool for diagnostic accuracy studies (quality assessment of diagnostic accuracy studies questionnaire),we found substantial risks of bias and/or applicability. conclusions-there is insufficient evidence to support that e/e' can reliably estimate lvfp in preserved ef. the diagnostic accuracy of e/e' to identify/exclude elevated lvfp and dd/hfpef is limited and requires further validation in a well-designed prospective clinical trial. © 2016 the authors.