Normal Values and Reference Ranges for the Ratio of Transmitral Early Filling Velocity to Early Diastolic Strain Rate: The Copenhagen City Heart Study

Abstract

The ratio of transmitral early filling velocity to early diastolic strain rate (E/e'sr) has recently emerged as a measure of left ventricular filling pressure. Reference values are needed for this new parameter for it to be used clinically. Healthy participants from a prospective general population study, the 5th Copenhagen City Heart Study, were used to establish reference values for E/e'sr derived from two-dimensional speckle tracking echocardiography. The prevalence of abnormal E/e'sr was assessed in participants with cardiovascular risk factors or specific diseases. The population comprised 1,623 healthy participants (median age: 45, IQR: 32-56, 61% females). The upper reference limit for E/e'sr in the population was 79.6cm. Following multivariable adjustment, males exhibited significantly higher E/e'sr than females (upper reference limit for males: 83.7cm and for females: 76.5cm). For both sexes, E/e'sr increased in a curvilinear fashion with age such that the largest increases in E/e'sr were observed in participants >45years. In the entire CCHS5 population with E/e'sr available (n=3,902), increasing age, BMI, systolic blood pressure, male sex, eGFR, and diabetes were associated with E/e'sr (all p<0.05). Total cholesterol was associated with a less steep increase in E/e'sr. Abnormal E/e'sr was seldomly observed in participants with normal diastolic function but became more frequent in participants with increasing grades of diastolic dysfunction (normal, mild, moderate, severe (abnormal E/e'sr in normal, mild, moderate, and severe diastolic dysfunction; 4.4% vs. 20.0% vs. 16.2% vs. 55.6%). E/e'sr differ between sexes and is age dependent such that E/e'sr increases with advancing age. Therefore, we established sex- and age-stratified reference values for E/e'sr.