E/A ratio

Q: What does an E/A below 1 mean?

It is an early sign of impaired left ventricular relaxation. It is common in older people and without symptoms, but combined with shortness of breath it warrants a workup.

Q: Can the E/A be improved?

You cannot directly 'train' the value, but controlling blood pressure, weight and blood sugar and regular aerobic exercise slow the worsening of diastolic function.

The ratio of early to late filling velocities of the left ventricle

Doppler echocardiography: the E and A peaks of transmitral flow

The E/A ratio is an echocardiography measure that describes how the left ventricle fills with blood during diastole. E is the peak of early passive filling, A is the peak created by atrial contraction.

The ratio of these peaks is a key marker of the heart's diastolic function.

Reference ranges

The peak E and A velocities are measured with pulsed-wave Doppler at the mitral valve:

Normal E/A	0.8 – 2.0
Impaired relaxation (grade I)	< 0.8
Restrictive pattern (grade III)	≥ 2.0

Important: In the 'pseudonormal' pattern (grade II), the E/A looks normal, but filling pressure is elevated — e′ and E/e′ are assessed in addition.

What an elevated level means

A high E/A (≥2) with a short deceleration time is a restrictive filling pattern: the ventricle is rigid and left atrial pressure is high. This is severe diastolic dysfunction, often in heart failure.

What a low level means

A low E/A (<0.8) is impaired ventricular relaxation (grade I). It is an early and common finding with aging, left ventricular hypertrophy and hypertension. It is rarely dangerous by itself but calls for monitoring.

How the test is done

The E/A is obtained on transthoracic echocardiography with Doppler. The value depends on age, heart rate and circulating blood volume, so it is interpreted together with e′ (tissue Doppler), E/e′, left atrial volume and the tricuspid regurgitation velocity.

What affects the value

Age: over the years E falls, A rises, and E/A decreases.
Heart rate and arrhythmias (for example, atrial fibrillation).
Dehydration or fluid overload changes preload.

Calculate using this marker

Calculators where E/A ratio is used directly:

Heart Age (Echo) A neural network reads five echocardiogram parameters — accurate to within ±5 years Open Heart Age AI analysis of your ECG — the biological age of your cardiovascular system Open

Frequently asked questions

What does an E/A below 1 mean?

It is an early sign of impaired left ventricular relaxation. It is common in older people and without symptoms, but combined with shortness of breath it warrants a workup.

Can the E/A be improved?

You cannot directly 'train' the value, but controlling blood pressure, weight and blood sugar and regular aerobic exercise slow the worsening of diastolic function.

Sources

info

This content is educational and does not replace consultation with a physician. Reference ranges may vary depending on the laboratory and method — rely on the ranges stated on your own test report.

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