S. N. Nallapati et al.
Although the E/e’ ratio is a robust marker in the predictio n of left ventricular filling pressure, it is imperfect
and sho uld be interpr eted wit h conside ration o f many si tuatio ns such a s severe mitral annular calcification, sig-
nificant mitral stenosis, moderate-to-severe mitral regurgitation, severe left ventricular dysfunction, and hyper-
trophic cardiomyopathy. These conditions can be a source of misleading information in the setting of acute
myocardial infarction [3].
Study Limitations
Our study has certain limitations: 1) the sample size is inadequate to draw conclusions in whole population; 2)
echocardiographer was not blinded in this study, which might impact selection bias; 3) certain compounding
factors like PCI/CABG and compliance of drug intake were not considered in the analysis, which might influ-
ence t he study fi ndings; 4) Since E/e’ ratio reflects an instantaneous measure of left ventricular filling p ressure,
a single measurement may not convey maximal prognostic information as the left ventricular filling pressure
may change over the course of the peri-infarct period; and 5) the follow-up period was only 6 months, which is
not enough to draw significant co ncl us io ns of sur v iva l. We s ug ges t tha t st ud ie s i nvo l vi ng l ar ge r sample -size and
long-term follow-up would offer necessary insights regarding the prognostic value of E/e’ ratio. We are of opi-
nion that echocardiographic estimation of E/e’ can be used as a valuable bed-size tool in the risk-strati ficatio n of
the patients with acute myocardial infarction.
5. Conclusion
Findings of the present study suggest that an E/e’ ratio >15 is a powerful predictor of decreased survival after
acute STEMI. Further studies are warranted to substantiate the findings. However, we opine that measurement
of E/e’ may assist ris k-stratification of patie nts in this settin g.
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