Left Ventricular Filling Pressure

E/e′ ratio is a useful estimate of left ventricular filling pressure (LVFP) and left atrial pressure (LAP)

• Average E/e′ < 8 strongly suggests normal LV filling pressure

• Average E/e′ > 14 strongly suggests elevated LV filling pressure (*PCWP >15 mmHg)

• If only one annulus can be measured:

  • Lateral E/e′ > 13 or

  • Septal E/e′ > 15 = elevated filling pressures

Physiology

As diastolic dysfunction worsens:

• e′ decreases - impaired relaxation

• E increases - rising filling pressures

  • therefore, E/e′ increases

Important Limitations

Interpret E/e′ cautiously in:

• LBBB or paced rhythm

• Mitral valve repair/replacement or severe annular calcification

• Pericardial disease

• Significant mitral regurgitation

• Regional wall motion abnormalities

• Normal LVEF (less accurate than in reduced LVEF)

Effect of Age

• e′ decreases with age

• E/e′ may rise slightly in older adults.

• However, E/e′ > 14 remains uncommon in healthy individuals of any age and generally supports elevated filling pressures

E/e′ is one of the best single Doppler markers of raised LV filling pressure, but it should never be used in isolation. Always interpret it alongside the full diastolic assessment and clinical context

*PCWP Pulmonary Capillary Wedge Pressure