Purpose : Impaired relaxation pattern (grade 1 diastolic dysfunction) by Doppler echocardiography is known to reflect preserved left ventricular filling pressure (LVFP), while increased ratio of early diastolic transmitral flow velocity to mitral annular velocity (E/E���) indicated elevated LVFP. We evaluated the characteristics of impaired relaxation pattern with elevated E/E��� ratio. Methods : Eighty-eight patients (mean age 63 짹 11, 59 males) who had coronary artery disease with impaired relaxation pattern (E/A < 1) were enrolled. Echocardiography including tissue Doppler imaging (TDI) was performed. All patients underwent cardiac catheterization to investigate LV pre-A pressure (LVPpre-A) within 6 hours after echocardiographic measurement. Patients were divided into subjects with E/E��� < 10 (n = 71) and E/E��� ��� 10 (n = 17). Results : LVPpre-A was well correlated with echocardiographic Doppler and hemodynamic parameters (E/E���, r = 0.536, p < 0.001; LA volume, r = 0.295, p = 0.008; EF, r = -0.234, p = 0.028). Forty (45% of total) patients had high LVFP, defined as LVPpre-A ��� 15 mmHg. Patients with E/E��� ��� 10 had a significantly higher incidence of high LVFP, when compared to patients with E/E��� < 10 (88% vs 35%, p < 0.001). LA volume and LVPpre-A were significantly increased and EF was decreased in patients with E/E��� ��� 10 (table1). However, there were no significant differences of parameters derived from transmitral inflow and transpulmonary venous flow between two groups. Conclusions : In patients with impaired relaxation pattern, elevated E/E��� has related to elevation of LVFP, regardless of transmitral inflow and transpulmonary indices. Therefore, impaired relaxation pattern with elevated ratio of early diastolic transmitral flow velocity to mitral annular velocity (E/E���) may have been considered as another grade of diastolic dysfunction.