E/E' ratio is more sensitive than E/A ratio for detection of left ventricular diastolic dysfunction in patients with systemic sclerosis

Abstract

OBJECTIVES: To investigate the efficiency of early filling (E) and early diastolic mitral annular velocity (E') ratio (E/E' ratio) assessed by tissue Doppler imaging (TDI) on early detection of diastolic left ventricular (LV) dysfunction in systemic sclerosis (SSc) patients without congestive heart failure (CHF) symptoms.

METHODS: Thirty-five Korean SSc patients without CHF symptoms and 35 healthy, age-sex matched controls were studied. Two-dimensional and M-mode echocardiography including conventional and tissue Doppler imaging was performed and pulmonary function test with diffusing capacity of lung for carbon monoxide was assessed.

RESULTS: Mean E and late filling (A) ratio (E/A ratio) showed no significant difference between the two groups, while TDI showed that SSc patients had significantly elevated E/E' ratio (10.6+/-4.2 vs. 8.8+/-2.2, p=0.032), in comparison with controls. SSc patients who had taken angiotensin converting enzyme inhibitor or angiotensin II receptor blocker had significantly lower E/E' than those who had not (8.0+/-2.4 vs. 11.9+/-4.3, p=0.01).

CONCLUSIONS: E/E' ratio is more sensitive than E/A ratio for identifying LV diastolic dysfunction in SSc patients without CHF symptoms. Furthermore, SSc patients who had received ACEI or ARB treatment showed significantly better preservation of LV diastolic function than those who had not received these medications.