Which statement best describes the meaning of a high E/e' ratio on Doppler echocardiography?

• A. It indicates lower LV filling pressures.
• B. It indicates similar LV filling pressures as normal.
• C. It indicates moderate LV filling pressures.
• D. It indicates higher LV filling pressures.

Answer: (D)

A high E/e' ratio on Doppler echocardiography signals elevated left ventricular filling pressures. The E velocity reflects the pressure gradient driving early diastolic filling from the left atrium into the ventricle, while e' (tissue Doppler of the mitral annulus) reflects the ventricle’s relaxation. When LV filling pressures are high, the gradient driving filling increases (E goes up) and myocardial relaxation is impaired (e' goes down). The combination raises the ratio, indicating higher LV filling pressures. In practice, an E/e' ratio above about 14 suggests elevated LV filling pressures, while a ratio below about 8 suggests normal pressures; values in between are less clear and should be interpreted with other findings.