Atrial fibrillation (AF), left atrial appendage thrombi (LAAT) and subsequent embolic stroke are the most frequent complications of mitral stenosis .E/Ea is used traditionally for the assessment of left atrium pressure, and besides AF and dilated LA size which promotes stasis of blood in LA, high LA pressure also play a role to clot formation in LA .The receiver operator characteristics (ROC) curve point-coordinates identified an E:e’ value of ≥ 36.5to have 57.14% sensitivity and 90.91% specificity for LAAT;We find this ratio relatively specific for prediction of LAAT, independent of MVA and LA volume, however it needs to be externally validated.