The ratio between early mitral flow wave to early diastolic mitral annulus velocity (E/e’ ratio) varies according to age and sex and is associated with mortality in heart failure. We sought to describe the association between E/e’ and mortality in patients with no apparent structural or functional cardiac abnormality and explore possible modifiers of this association. A retrospective study of 104,315 patients who underwent echocardiographic evaluation during 2009-2021 in the largest tertiary center in Israel. Patients with cancer, ventricular dysfunction, significant valvular or structural heart disease, or evidence of pulmonary hypertension were excluded. The final analysis included 32,836 patients with a median age of 56 (43-66) years, and 13,547 (41%) were female. The median E/e’ was 8.3 (6.8-10.3), and 9,306 (28%) had an E/e’ >10. During a median follow-up of 5.7 (3.3-8.5) years, 2,396 (7.3%) individuals died. E/e’ >10 was associated with mortality (adjusted hazard ratio [HR] 1.16, 95% confidence interval [CI] 1.07-1.27, p<0.001). The mortality risk associated with E/e’ >10 was significantly higher in those aged ≤70 (HR 1.26, 95% CI 1.12-1.42, p<0.001), males (HR 1.34, 95% CI 1.19-1.49, p<0.001), a normal left ventricular mass (HR 1.13, 95% CI 1.02-1.24, p = 0.017), and pulmonary artery pressure <30 mmHg (HR 1.18, 95% CI 1.06-1.30, p = 0.003). An elevated E/e’ is associated with mortality, specifically in younger individuals, males, and those with a normal left ventricular mass and lower pulmonary artery pressure. This suggests that an elevated E/e’ might be a marker of subclinical risk in these subgroups. Further studies are needed to identify whether an elevated E/e' is useful in shared decision-making regarding the management of cardiovascular risk factors.

中文翻译：

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无明显结构性或功能性心脏异常的患者中 E/e' 比与生存率之间关联的修正因素

早期二尖瓣血流波与早期舒张期二尖瓣环速度之间的比率（E/e'比率）根据年龄和性别而变化，并且与心力衰竭的死亡率相关。我们试图描述 E/e' 与无明显结构或功能性心脏异常的患者死亡率之间的关联，并探索这种关联的可能修正因素。对 2009 年至 2021 年期间在以色列最大的三级中心接受超声心动图评估的 104,315 名患者进行的回顾性研究。患有癌症、心室功能不全、严重瓣膜或结构性心脏病或有肺动脉高压证据的患者被排除在外。最终分析纳入了 32,836 名患者，中位年龄为 56 (43-66) 岁，其中 13,547 名 (41%) 为女性。E/e' 中位数为 8.3 (6.8-10.3)，9,306 名 (28%) 的 E/e' >10。在中位随访 5.7 (3.3-8.5) 年期间，有 2,396 人 (7.3%) 死亡。E/e' >10 与死亡率相关（调整后的风险比 [HR] 1.16，95% 置信区间 [CI] 1.07-1.27，p<0.001）。与 E/e' >10 相关的死亡风险在 ≤70 岁的人群中显着较高（HR 1.26，95% CI 1.12-1.42，p<0.001），男性（HR 1.34，95% CI 1.19-1.49，p<0.001） ）、左心室质量正常（HR 1.13，95% CI 1.02-1.24，p = 0.017），肺动脉压<30 mmHg（HR 1.18，95% CI 1.06-1.30，p = 0.003）。E/e' 升高与死亡率相关，特别是在年轻个体、男性以及左心室质量正常和肺动脉压力较低的个体中。这表明 E/e' 升高可能是这些亚组中亚临床风险的标志。需要进一步的研究来确定升高的 E/e' 是否有助于心血管危险因素管理的共同决策。