High E/e’ tied to poor prognosis in HFrecEF

In patients with heart failure and recovered ejection fraction (HFrecEF), having a high ratio between the peak velocity of the early wave to early diastole (E/e’) may signal worse clinical prognosis, a recent study has found.

Researchers retrospectively evaluated 96 HFrecEF patients whose diastolic function was assessed as the E/e’ ratio 1 year after diagnosis. Participants were divided into two groups according to an E/e’ ratio cutoff of 12.1. The composite endpoint was cardiovascular (CV) death and HF readmission.

After a median follow-up of 537 days after the 1-year visit, 14 patients were either readmitted for HF or died due to CV events, yielding an overall rate of 15 percent. Of these, only one patient died directly due to a CV disease.

Receiver operating characteristic curve analysis confirmed that at the cutoff of 12.1, E/e’ was a good predictor of the composite outcome, with an area under the curve of 0.70 (95 percent confidence interval [CI], 0.55–0.84).

In turn, Kaplan-Meier analysis found that the composite endpoint occurred at a significantly higher frequency in patients in the high vs low E/e’ ratio subgroup (log-rank p=0.01). This was confirmed by multivariate Cox regression analysis, which identified E/e’ ratio ≥12.1 at the 1-year visit as a significant risk factor for the composite endpoint (hazard ratio, 5.45, 95 percent CI, 1.23–24.1).

“Further large-scale, prospective investigations are needed to determine the best management for patients with HFrecEF and high E/e′ ratio,” the researchers said.