Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Niels Andersens vej 65, Post 835, 2900, Copenhagen, Denmark.
Division of Cardiology, University of California, San Francisco UCSF, San Francisco, USA.
J Echocardiogr. 2020 Jun;18(2):94-104. doi: 10.1007/s12574-020-00466-w. Epub 2020 Mar 18.
The ratio of transmitral early filling velocity to early diastolic strain rate (E/e'sr) has recently emerged as a novel and accurate non-invasive measure of left ventricular (LV) filling pressure. This systematic review and meta-analysis aimed to give an overview of the possible clinical implications of E/e'sr.
We conducted a systematic review and meta-analysis of all studies involving E/e'sr. Of 598 identified studies, 16 met our inclusion criteria. Studies involving E/e'sr either investigated its prognostic value (n = 9) or its correlation with invasively measured LV filling pressure (n = 7).
The pooled meta-analysis showed a significant correlation between E/e'sr and pulmonary capillary wedge pressure (PCWP) measured invasively across the studies assessing this relationship (Cohen's d = 3.90 95% CI [2.38-6.39], p < 0.001) and between E/e'sr and left ventricle end-diastolic pressure (LVEDP) measured invasively across the studies assessing this relationship (Cohen's d = 5.30 95% CI [2.83-9.96], p < 0.001). The pooled analysis of the prognostic studies showed that E/e'sr was a significant predictor of adverse outcomes after multivariable adjustment across the different study populations in a random effects model (overall estimated HR: 1.58 95% CI [1.28-1.96], p < 0.001, per 1 m increase).
E/e'sr correlates well with invasive measures of LV filling pressure. In addition, E/e'sr provides significant prognostic information across various patient populations. Further studies are needed to test if E/e'sr has an advantage to E/e'.
二尖瓣早期充盈速度与早期舒张应变率的比值（E/e'sr）最近作为一种新的、准确的左心室（LV）充盈压无创测量方法出现。本系统评价和荟萃分析旨在概述 E/e'sr 的可能临床意义。
我们对所有涉及 E/e'sr 的研究进行了系统评价和荟萃分析。在 598 项确定的研究中，有 16 项符合我们的纳入标准。涉及 E/e'sr 的研究要么研究其预后价值（n=9），要么研究其与侵入性测量的 LV 充盈压的相关性（n=7）。
汇总荟萃分析显示，在评估这种关系的研究中，E/e'sr 与通过侵入性测量的肺毛细血管楔压（PCWP）之间存在显著相关性（Cohen's d=3.90，95%置信区间[2.38-6.39]，p<0.001），并且在评估这种关系的研究中，E/e'sr 与通过侵入性测量的左心室舒张末期压（LVEDP）之间存在显著相关性（Cohen's d=5.30，95%置信区间[2.83-9.96]，p<0.001）。在多变量调整后，预后研究的汇总分析显示，E/e'sr 是不同研究人群不良结局的显著预测因子，在随机效应模型中（总体估计 HR：1.58，95%置信区间[1.28-1.96]，p<0.001，每增加 1 个单位）。
E/e'sr 与 LV 充盈压的侵入性测量方法密切相关。此外，E/e'sr 在各种患者人群中提供了重要的预后信息。需要进一步的研究来测试 E/e'sr 是否优于 E/e'。
