Which statement about the transmitral E/A ratio is accurate?

Which statement about the transmitral E/A ratio is accurate?

• A. It measures LV systolic function directly.
• B. It is unaffected by age.
• C. It reflects LV filling pattern and changes with age and diastolic dysfunction.
• D. It directly estimates left atrial pressure.

Answer: (C)

The transmitral E/A ratio is a Doppler index of how the left ventricle fills during diastole. The E wave reflects early, passive filling, while the A wave reflects filling that occurs with atrial contraction. This ratio mainly tells us about the LV filling pattern, which is governed by relaxation and chamber compliance, and it changes as people age as well as with diastolic dysfunction. That’s why the correct statement is that the E/A ratio reflects LV filling pattern and changes with age and diastolic dysfunction. In younger, healthy hearts the E wave tends to exceed the A wave (E/A > 1), indicating efficient early filling. With aging or impaired relaxation, the E wave diminishes and the A wave becomes more prominent, lowering the ratio. In different stages of diastolic dysfunction, the pattern evolves from reduced E (with a low E/A) to pseudonormal patterns as filling pressures rise, and finally to a restrictive pattern with a very high E due to elevated filling pressures. This ratio does not measure LV systolic function directly, is not unaffected by age, and does not provide a direct estimate of left atrial pressure, though it can be influenced by loading conditions and should be interpreted alongside other diastolic parameters.

The transmitral E/A ratio is a Doppler index of how the left ventricle fills during diastole. The E wave reflects early, passive filling, while the A wave reflects filling that occurs with atrial contraction. This ratio mainly tells us about the LV filling pattern, which is governed by relaxation and chamber compliance, and it changes as people age as well as with diastolic dysfunction.

That’s why the correct statement is that the E/A ratio reflects LV filling pattern and changes with age and diastolic dysfunction. In younger, healthy hearts the E wave tends to exceed the A wave (E/A > 1), indicating efficient early filling. With aging or impaired relaxation, the E wave diminishes and the A wave becomes more prominent, lowering the ratio. In different stages of diastolic dysfunction, the pattern evolves from reduced E (with a low E/A) to pseudonormal patterns as filling pressures rise, and finally to a restrictive pattern with a very high E due to elevated filling pressures. This ratio does not measure LV systolic function directly, is not unaffected by age, and does not provide a direct estimate of left atrial pressure, though it can be influenced by loading conditions and should be interpreted alongside other diastolic parameters.