diastolic heart failure

[malan]

Hello,
Would anyone know if E/A ratio of 2, as seen in the doppler echo, indicates diastolic heart failure when the EF is normal?
Thnx

[malan]

Thnx for the post, and sorry for the rather delayed response. The echo indicates trivial regurgitation. To confirm diastolic heart failure, a BNP test seems to be useful, though for some odd reason my doc failed to consider this. Also, to find out if the e/a ratio is normal or pseudo-normal, it seems to be necessary for the echo to do a TDI reading, which again was omitted in my echo. ( I came across this in an informative youtube video on diastolic heart failure). I am trying to look for a doc to whom I can mention these things.
Thnx again and with best wishes,
Malan

[ed34]

Good question.
The answer is to try and picture what is going on. It's all about the timing and flexibility and healthy valves, in particular the Mitral valve which seperates the two left chambers. Another factor of course is pressure but you would need severe hypertension to really have a negative effect and this would have been highlighted and treated long before now.
So, the timing and flexibility. The left ventricle must contract to push oxygenated blood out through your body. We know this is a good function by your EF. Now comes the relaxation. The left ventricle must be nice and elastic to quickly relax, in readiness to accept more blood before it contracts again. If you have rhythm problems occasionally, this can cause the ventricle to contract again before sufficient blood has been delivered into it. This will make you light headed and likely increase your breathing rate. However, it isn't serious in most cases for this to happen for anything to 4 beats at a time a few times a day. It will normally be treated if it really affects your quality of life. Your left ventricle is relaxing quickly, the velocity of blood from (E) is high. This means there is plenty of room for that blood to drop down and reach such a velocity. If (E) was lower then it could show that the ventricle is not relaxed yet, indicating CAD or even cardiomyopathy. Then comes (A), and again this needs to reach a good velocity, but it can depend on some factors. The condition of the mitral valve or the action of the Atria contracting. Another reason that (A) could be slower is that the ventricle is already 3 quarters full. The (E) stage in some people will fill the ventricle by 70%, others could be up to 75-77%. The Atria would not need to fill the ventricle so much with the latter figures, so the velocity would be harder to reach. Trying to squeeze blood into something virtually already full is difficult.
So the numbers can mean different things, some good, even if the ratio is higher. If (E) was high and (A) was low, then I would be concerned. This means that the blood is falling  So if (E) was very high, and (A) very low, then you would have to suspect a seriously leaking mitrial valve. If (E) was very low and (A) was very high, then again you would need to be concerned because the ventricle obviously hasn't relaxed quickly enough. As you see, (E) low and (A) high would give a negative ratio, something which would require immediate attention.
Out of interest, what did the echo report state about your valves? in the way of regurgitation.

[malan]

Thnx ed for the post. The reason I was worried is that I read somewhere that with diastolic dis-function, the e/a ratio at first falls below the normal range of 0.75 to 1.5. As the dis-function progresses, the ratio goes above 1.5. Also, I had experienced symptoms of heart failure like shortness of breath while exercising, unusual fatigue, arrhythmia identified as NSVT, etc, just prior to this echo. So, since the symptoms seemed to co-relate with the e/a reading, I got worried, and thought the doctor had missed the danger by only considering the normal ef. (I am 50, male) However your post is more re-assuring, though I would like to know why you consider a higher ratio troubling.
Thnx again, and with best wishes,
Malan

[ed34]

I can tell you what the E and A refers to.
When your heart muscle contracts, a percentage of blood is ejected from the ventricles (as you know) and NOT all of it. Usually around half to three quarters leaves the Heart, leaving half to a quarter of the blood still in there. This is your EF.
Now, when the heart relaxes again, to refill with blood, pressure alone will push an amount through the Atria into the ventricles and this is measured with the speed (velocity) E. This leaves some blood in the Atria and the ventricles are not quite full yet, so the Atria now contract to squeeze blood down into the ventricles. The speed of the blood in this stage is measured in A. Usually they term E as the early filling, and A as the late filling.
With regards to your EA ratio, i.e. 2:1 or 8 to 4. If E is greater than A, then it is a good sign, and yours is. With diastolic dysfunction, ie stiff muscle, the A would be greater than the E. The early phase (E) contributes around 80% of the filling, while the top up from (A) is around 20%. If your ratio was much larger than 2 then I would be asking questions. Personally your heart looks quite efficient to me. The other thing to remember, although you don't state your age, is that heart muscle does stiffen as we get older. If a Cardiologist believed that your have diastolic heart failure, you would have been put on medication and had plans of action discussed with you.

[malan]

Thnx Jerry for the observations. I think I will need to consult a doctor regarding this once again. Just one question: are you on medication or on supplements for your AFib?
Best wishes,
Malan

[Jerry_NJ]

Your explanation and the tact you now have a thread going may bring on some with more experience and knowledge on your question.  

As I have commented on another post asking if their EF was too high, I believe being off average is not necessarily bad - it can be goo, i.e., better than average.  The lab tests I have read always compare measures against the normal.  Sometime either high or low is bad, such as when measuring PROTIME, the coagulation of blood.

As I may have already said, my atrial are out of the game and my EF is fine and I have never been diagnosed with diastolic heart failure, but AFib my in fact just be one version of that diagnosis.  :Sorry I forget which cycle of the heart pumping diastolic is, but I'll guess it is the loading of the ventricles.  

[malan]

Thanks Jerry for the post. I have symptoms of heart failure like fatigue, shortness of breath, tachycardia, etc, with normal (60%) ejection fraction. I read on the net that one can have diastolic heart failure with a normal ef, and the way to diagnose that is to look at the E/A ratio in the Doppler echo. My echo mentioned the E and A numbers as 8 and 4 respectively. This indicates a higher ratio than the 1.5 which is considered normal. This could, according to the write-up, indicate diastolic hf. However, my doctor mentioned nothing about all this, and seems to have taken only the ef of 60% into account in ruling out heart failure. That's why I have come to Medhelp.
Thanks again, and if you find out anything about the E/A ratio, please let me know.
Regards and best wishes,
Malan

[Jerry_NJ]

Your question is rather brief and technical, that may be why no help has surfaced, save this comment.

I believe an EF (Ejection Fraction) over 50% (over 60% much better) considered good.  I do not know what  E or A thus E/A, stand for. Thus I do not have any help there.

Did you numbers come from an echocardiogram?  If so the doctor should interpret the results for you. If my doctor said to me "diastolic heart failure"  I'd say WHAT?  Please explain what is next.