Paradoxical increase in E/e' ratio after treatment of heart failure in two patients with preserved ejection fraction.

We report an increase in E/e' ratio after treatment of heart failure (HF) in two patients. In case 1, the E/e' ratio increased from 15 to 18 after treatment of HF. In case 2, the E/e' ratio also increased from 24 to 35. Although a high E/e' ratio suggests high pulmonary artery wedge pressure and worsening HF, the ratio may increase after improvement of HF.In the present cases of diastolic dysfunction, the high E wave did not change, but the e' wave decreased relatively. This report may suggest difficulty in evaluating hemodynamic status based on the E/e' ratio in patients with diastolic dysfunction.