Regional wall motion abnormality at the lateral wall disturbs correlations between tissue Doppler E/e' ratios and left ventricular diastolic performance parameters measured by invasive methods

Background: The impact of regional wall motion abnormality (RWMA) on the accuracy of heart failure with preserved ejection fraction (HFpEF) diagnosis using the E/e' ratio, which is a non-invasive parameter of left ventricular diastolic performance, is unknown. The purpose of this study was to elucidate the impact of RWMA of the lateral wall (RWMAlat) on the correlation between E/e' and invasive parameters of left ventricular diastolic performance.

Methods: Three hundred and eight consecutive patients undergoing tissue Doppler imaging and catheterization pressure examination were retrospectively analyzed. E/e' was calculated as the ratio of early diastolic transmitral flow velocity to mitral annular velocity at the lateral wall. Invasive parameters including left ventricular end-diastolic pressure (LVEDP) and isovolumetric relaxation time constant (τ) were assessed based on the left ventricular pressure study. Correlation coefficients between E/e' and these invasive parameters were analyzed and compared between cases with RWMAlat and without RWMA.

Results: LVEDP and τ correlated well with E/e' for all 308 patients (r = 0.51 and r = 0.65, respectively). Sixty-two patients had RWMA; the remaining 246 did not have RWMAlat. We confirmed that the presence of RWMAlat weakens both the correlations between E/e' and LVEDP (r = 0.574 vs. r = 0.381), and E/e' and τ (r = 0.729 vs. r = 0.461).

Conclusions: Although E/e' correlates well with parameters of left ventricular diastolic performance assessed by invasive methods, the presence of RWMAlat worsens this correlation. In cases with RWMAlat, careful assessment is required for HFpEF diagnosis because the diagnostic value of the E/e' ratio could be decreased compared to patients without RWMAlat.