Echocardiographic assessment of diastolic function (mitral inflow E/A ratio)
Core concept
- Diastolic dysfunction = impaired relaxation (active, ATP-dependent) and/or increased stiffness (passive)
- -> the ventricle can only fill at a higher pressure -> inc LA pressure -> inc LA volume -> pulmonary congestion
- No single measure works - use a combination
| Measure | What it reflects | Abnormal |
|---|---|---|
| Mitral inflow E/A | Early passive vs atrial filling | Load-dependent, pseudonormalises |
| Tissue Doppler e' (mitral annulus) | Myocardial relaxation - relatively load-independent | Septal e' <7, lateral e' <10 cm/s |
| E/e' | LV filling pressure surrogate | Average >14 (septal >15, lateral >13) |
| LA volume index | Chronic exposure to raised filling pressure - "the HbA1c of diastology" | >34 mL/m2 |
| Peak TR velocity | Pulmonary artery systolic pressure | >2.8 m/s |
- The four-variable algorithm - if >=3 of 4 are abnormal (average E/e' >14, septal e' <7 or lateral e' <10, TR velocity >2.8, LAVI >34) -> diastolic dysfunction with raised filling pressures
- 2 of 4 = indeterminate; add strain, pulmonary vein flow, Valsalva, or exercise
3 more sections, plus exam facts
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