Background The ratio of transmitral early filling velocity to early diastolic strain rate (E/eMODIFIER LETTER PRIMEsr) has recently emerged as a novel and accurate non-invasive measure of left ventricular (LV) filling pressure. This systematic review and meta-analysis aimed to give an overview of the possible clinical implications of E/eMODIFIER LETTER PRIMEsr. Methods We conducted a systematic review and meta-analysis of all studies involving E/eMODIFIER LETTER PRIMEsr. Of 598 identified studies, 16 met our inclusion criteria. Studies involving E/eMODIFIER LETTER PRIMEsr either investigated its prognostic value (n = 9) or its correlation with invasively measured LV filling pressure (n = 7). Results The pooled meta-analysis showed a significant correlation between E/eMODIFIER LETTER PRIMEsr and pulmonary capillary wedge pressure (PCWP) measured invasively across the studies assessing this relationship (Cohen's d = 3.90 95% CI [2.38-6.39], p <0.001) and between E/eMODIFIER LETTER PRIMEsr and left ventricle end-diastolic pressure (LVEDP) measured invasively across the studies assessing this relationship (Cohen's d = 5.30 95% CI [2.83-9.96], p <0.001). The pooled analysis of the prognostic studies showed that E/eMODIFIER LETTER PRIMEsr was a significant predictor of adverse outcomes after multivariable adjustment across the different study populations in a random effects model (overall estimated HR: 1.58 95% CI [1.28-1.96], p <0.001, per 1 m increase). Conclusion E/eMODIFIER LETTER PRIMEsr correlates well with invasive measures of LV filling pressure. In addition, E/eMODIFIER LETTER PRIMEsr provides significant prognostic information across various patient populations. Further studies are needed to test if E/eMODIFIER LETTER PRIMEsr has an advantage to E/eMODIFIER LETTER PRIME.