The E/e' ratio in the gray zone as predictor of left atrial dysfunction in patients with normal left ventricular ejection fraction: A speckle tracking study

The results of this study add to previous findings by showing that an independent association between the E/e′ ratio and LA strain indexes may exist in patients with normal ejection fraction and an E/e′ value ranging in the gray zone. In our population, E/e′ showed good discrimination for the prediction of LA dysfunction, and was found to be the strongest determinant of most LA strain indexes. From a practical point of view, a cut‐off of E/e′ > 10.6 may be used to predict with good accuracy a reduction in PALS – i.e., a global impairment in LA function – and in LASRsyst—i.e., an impairment in LA reservoir function. Similarly, a cut-off of E/e′ > 10.8 may be used to predict a reduction in LASRearly, i.e., an impairment in LA conduit function. As measurement of E/e′ can be performed in daily practice more easily and rapidly than LA strain imaging, such information might be useful to identify a subset of patients for whom a more detailed assessment of LA function by speckle tracking would be appropriate.