E/e’ Ratio 15 or Higher Ups Risk for 5-Year Mortality for Patients With PTA for PAD

atherosclerosis, CAD, coronary artery disease, plaque
atherosclerosis, CAD, coronary artery disease, plaque
Investigators sought to determine whether elevated E/e’ ratio is an independent predictor for mortality at 5 years among patients undergoing percutaneous transluminal angioplasty for peripheral artery disease.

Long-term mortality was associated with E/e’ ratio of left atrium ³15 among patients with peripheral artery disease (PAD) who were undergoing percutaneous transluminal angioplasty (PTA), according to results of a study published in Heart and Vessels.

This study analyzed the PTA registry, which began collecting data at the Korea University Guro Hospital in 2004. Investigators used transthoracic echocardiography to assess patients (N=902) undergoing PTA for PAD. Cardiovascular (CV) morphology parameters were associated with clinical outcomes and all-cause mortality at 5 years.

Patients were a mean age of 68±10 years, and 77% were men. Most patients (n=764) had preserved ejection fraction (EF), 76 had mid-range EF, and 62 had reduced EF. On the basis of EF, patients differed significantly for rates of chronic renal insufficiency (P <.001), atrial fibrillation (P <.001), coronary artery disease (P <.001), dialysis (P =.001), and percutaneous coronary intervention during PTA (P =.014).

At echocardiography, patients with reduced EF had lower left ventricular EF (P <.001) and regional wall motion abnormalities (P <.001) and higher mitral regurgitation (P <.001), E/e’ ratio (P <.001), pulmonary artery pressure (P <.001), and tricuspid valve regurgitation (P =.001).

At 30-days after PTA, mortality was 2%, and the rate did not differ on the basis of EF.

At 5 years, researchers observed 140 CV events, including 81 deaths. All-cause mortality was elevated among patients with reduced EF (19.7%) compared with preserved EF (8.9%; P <.01). Similarly, CV events were 1.4 times more likely among patients with reduced EF (P =.04).

Significant predictors of mortality were E/e’ ratio (hazard ratio [HR] 1.11 [95% CI, 1.07-1.16]; P <.001), longer intensive care unit (ICU) stay (HR 1.06 [95% CI, 1.03-1.09]; P <.01), and heart rate (HR 1.02 [95% CI, 1-1.04]; P =.01). Major CV events were associated with E/e’ ratio and longer ICU stay (all P <.01).

Patients who had an E/e’ ³15 had an increased risk for mortality (HR 6.14 [95% CI, 3.7-10.1]; P <.01) and CV events (HR 2.8 [95% CI, 2-4]; P <.01). The 5-year mortality rate among patients with E/e’ ³15 was 81%. Patients with higher E/e’ ratio had more instances of multivessel disease (43% vs 28%; P <.01), chronic total occlusion (11% vs 5.5%; P =.02), elevated creatinine (2.8±3.1 mg/dL vs 1.6±2 mg/dL; P <.01), and longer stays in the ICU (1.2±5.2 days vs 0.5±2.5 days; P =.04).

Researchers collected these data at a single, tertiary referral hospital and, as such, may have included referral bias and may not be generalizable to other care settings.

The study authors concluded elevated E/e’ ratio was an independent predictor for mortality at 5 years among patients undergoing PTA for PAD.


Kim KH, Vallabhajosyula S, Rha SW, et al. Initial diastolic dysfunction is a powerful predictor of 5‑year mortality in peripheral arterial disease patients undergoing percutaneous transluminal angioplasty. Heart Vessels. Published online March 9, 2021. doi:10.1007/s00380-021-01823-0