Diagnostic Accuracy of Tissue Doppler Index E/è for Evaluating Left Ventricular Filling Pressure and Diastolic Dysfunction/Heart Failure With Preserved Ejection Fraction: A Systematic Review and Meta‐Analysis

Abstract

Background Tissue Doppler index E/è is used clinically and in multidisciplinary research for estimation of left ventricular filling pressure ( LVFP ) and diastolic dysfunction ( DD )/heart failure with preserved ejection fraction ( HF p EF ). Its diagnostic accuracy is not well studied. Methods and Results From the PubMed, Scopus, Embase, and Cochrane databases, we identified 24 studies reporting E/è and invasive LVFP in preserved EF (≥50%). In random‐effects models, E/è had poor to mediocre linear correlation with LVFP . Summary sensitivity and specificity (with 95% CIs ) for the American Society of Echocardiography–recommended E/è cutoffs (lateral, mean, and septal, respectively) to identify elevated LVFP was estimated by using hierarchical summary receiver operating characteristic analysis. Summary sensitivity was 30% (9–48%), 37% (13–61%), and 24% (6–46%), and summary specificity was 92% (82–100%), 91% (80–99%), and 98% (92–100%). Positive likelihood ratio ( LR +) was <5 for lateral and mean E/è. LR + was slightly >10 for septal E/è obtained from 4 studies (cumulative sample size <220). For excluding elevated LVFP , summary sensitivity for E/è (lateral, mean, and septal, respectively) was 64% (38–86%), 36% (3–74%), and 50% (14–81%), while summary specificity was 73% (54–89%), 83% (49–100%), and 89% (66–100%). Because of data set limitations, meaningful inference for identifying HF p EF by using E/è could not be drawn. With the use of quality assessment tool for diagnostic accuracy studies (Quality Assessment of Diagnostic Accuracy Studies questionnaire), we found substantial risks of bias and/or applicability. Conclusions There is insufficient evidence to support that E/è can reliably estimate LVFP in preserved EF . The diagnostic accuracy of E/è to identify/exclude elevated LVFP and DD / HF p EF is limited and requires further validation in a well‐designed prospective clinical trial.