Prognostic value of tissue Doppler E/e' ratio in hypertension patients with preserved left ventricular ejection fraction.

OBJECTIVES: This study aims to investigate the association of tissue Doppler E/e' with cardiac events in hypertension patients, independent of and incremental to clinical and left ventricular geometric patterns.

METHODS: We retrospectively enrolled 222 asymptomatic nonischemic patients with hypertension who had echocardiogram in 2012 to evaluate tissue Doppler E/e'. Patients were followed up for cardiac events (cardiac events were defined as myocardial infarction, coronary revascularization procedures, new-onset angina (stable or unstable), heart failure). A cox regression was used to assess the association of the ratio of transmitral Doppler early filling velocity to tissue Doppler early diastolic mitral annular velocity (E/e') with cardiac events.

RESULTS: A total of 222 patients were included in analysis. There were 10 primary cardiac events during 3.2 ± 0.4 years follow-up. The E/e' ratio was the strongest predictor of cardiac events in Cox-proportional hazards models. Following adjustment for covariates, a unit rise in the E/e' ratio was associated with a 26% increment in risk of a cardiac event (HR 1.26, CI 1.06-1.50, p = 0.008). When E/e' ＞14 the hazard ratio of cardiac event was significantly increased compared with E/e' ≤ 14 in Kaplan-Meier analysis (log-rank ratio, 16.26; p ＜ 0.001).

CONCLUSIONS: E/e', a non-invasive estimate of left ventricular filling pressure, predicts cardiac events in hypertensive population with preserved left ventricular ejection fraction, independent of and incremental to clinical and left ventricular geometric patterns. E/e' represents an early, effective tool for cardiovascular risk stratification in hypertension population.