Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Anesthesiology. 2012 Feb;116(2):362-71. doi: 10.1097/ALN.0b013e3182426ed6.
The ratio of early transmitral flow velocity to early diastolic velocity of the mitral annulus (E/e') correlates with left ventricular (LV) filling pressure. In particular, an E/e' ratio more than 15 is an excellent predictor of increased LV filling pressure. The authors evaluated the prognostic implications of preoperative estimated LV filling pressure, assessed by E/e' ratio, in patients undergoing off-pump coronary artery bypass graft surgery.
This observational study investigated 1,048 consecutive adults undergoing elective off-pump coronary artery bypass graft surgery. The primary outcome was occurrence of major adverse cardiac events (MACE), defined as a composite of death, myocardial infarction, malignant ventricular arrhythmia, cardiac dysfunction, or need for new revascularization. Logistic regression and survival analyses were performed.
An E/e' ratio more than 15 was independently associated with 30-day MACE (odds ratio 2.4, 95% CI 1.4-3.9, P = 0.001) and 1-yr MACE (hazard ratio 2.1, 95% CI 1.4-3.1, P = 0.001), irrespective of underlying LV ejection fraction. MACE free 1-yr survival rate was significantly decreased in patients with E/e' >15, irrespective of underlying LV ejection fraction.
Increased LV filling pressure, assessed by E/e' ratio, is an independent predictor of 30-day and 1-yr MACE in patients who undergo elective off-pump coronary artery bypass graft surgery. These findings indicate that measurements of E/e' may assist in preoperative risk stratification of these patients.
早期二尖瓣瓣环的血流速度与舒张早期速度之比（E/e'）与左心室（LV）充盈压相关。特别是，E/e'比值大于 15 是 LV 充盈压升高的极佳预测指标。作者评估了通过 E/e'比值评估的术前估计的 LV 充盈压在接受非体外循环冠状动脉旁路移植术的患者中的预后意义。
本观察性研究调查了 1048 例连续接受择期非体外循环冠状动脉旁路移植术的成年人。主要结局是发生重大不良心脏事件（MACE），定义为死亡、心肌梗死、恶性室性心律失常、心功能障碍或需要新血运重建的复合终点。进行了逻辑回归和生存分析。
E/e'比值大于 15 与 30 天 MACE（比值比 2.4，95%CI 1.4-3.9，P = 0.001）和 1 年 MACE（风险比 2.1，95%CI 1.4-3.1，P = 0.001）独立相关，而与基础 LV 射血分数无关。无论基础 LV 射血分数如何，E/e' >15 的患者的 1 年 MACE 无事件生存率显着降低。
通过 E/e'比值评估的 LV 充盈压升高是接受择期非体外循环冠状动脉旁路移植术的患者 30 天和 1 年 MACE 的独立预测指标。这些发现表明，E/e'的测量可能有助于这些患者的术前风险分层。
