Predictive value of E/A and E/E′ Doppler indexes for cardiac events in heart transplant recipients

Background Doppler‐derived indexes associated with high left ventricular filling pressures are risk factors for cardiac events in various populations. The aim of this study was to evaluate the predictive value of two of these Doppler indexes during the long‐term follow‐up of heart transplantation. Methods and Results In this cohort study, we measured E/A ratio combining early filling velocity (E) with late filling velocity (A) and E/E′ ratio combining E wave with relaxation velocity on tissue doppler (E′) in 122 transplant heart recipients, 6.9±5.9 years after transplantation. The patients were followed for 97±32 months after Doppler measurements. We found an E/A>2 in 68 patients and an E/E′>15 in 23 patients. Forty patients had a cardiac event (cardiac death, retransplantation, acute coronary events, hospitalization for heart failure, treated acute rejection episodes, and coronary revascularization procedures) during the follow‐up. In multivariate analysis, E/A and E/E′ were significantly associated with cardiac events (hazard ratio 2.2, 95% CI: 1.1–4.4; P=.02 and hazard ratio 2.3, 95% CI: 1.1–4.8; P=.02, respectively). E/E′, E/A, and significant coronary stenoses were the strongest predictors of cardiac events. Conclusions E/A and E/E′ Doppler indexes may be used to predict cardiac events during the long‐term follow‐up of heart transplant recipients.