Aortic Stenosis
  Aortic Insufficiency
  AV Prosthesis
  Mitral Stenosis
  Mitral Regurgitation
  Mitral Prosthesis
  Diastology
  Left Atrial Size
  Contact Us

  Diastology Animation
  Diastology Abn Stages
 
  Diastology
       
                   
    Mitral Flow E (m/sec) = Mitral Annulus E' (m/sec) = MV E/E' =    
    E/E' Values and LV diastolic pressure: <8 Normal ; >8, <=15 Indeterminate; >15 Elevated   (Circ 102:1788)    
         
                   
    Mitral Flow E (m/sec) = MV Flow Propagation Vp = E/Vp =    
    In CHF pts with normal LVEF, E/Vp >= 1.5 has a predictive accuracy of 94% for abn diastolic function (AJC 93:1057)  
       
       
     To trigger calculations, press TAB.              

 


A Practical Approach to the Echocardiographic Evaluation of Diastolic Function.

 Khouri SJ et al.  J Am Soc Echocardiogr 2004;17:290-7.

Terms:
A, A wave, the peak late diastolic transmitral flow velocity
Adur, Duration of A wave, the peak late diastolic transmitral flow velocity
ARdur, Pulmonary venous (PV) atrial reversal flow velocity duration
AR, Peak pulmonary venous atrial reversal flow velocity
D, Peak diastolic PV flow velocity
DT, deceleration time, measured from the peak of E to the baseline (normally <220 milliseconds)
E, E wave, the peak early diastolic transmitral flow velocity
Ea, Peak early diastolic myocardial velocity using Doppler tissue imaging
LV, Left ventricular
S, Peak systolic PV flow velocity
Vp, transmitral early diastolic flow propagation velocity in cm/sec using color M-mode Doppler
Valsalva, Valsalva maneuver performed during echocardiographic Doppler recording of transmitral flow

Values in parentheses ( ) are secondary criteria.

 

Normal LV diastolic function.

0.75 <  E/A < 1.5 and any one of the following:
AR<0.35
ARdur < Adur
No E/A reversal with Valsalva
Vp > 45 (Vp > 55 if less than 30 y.o.) or E/Vp < 1.5
E/Ea < 10
( 140 < DT (msec) < 220)
(S >= D)
 

Stage I diastolic dysfunction (“Impaired Relaxation”)

E/A < 0.75
E/Ea < 10
(DT  >220 milliseconds. Filling pressures are normal.)
(S > D)
(ARdur < Adur)

 

Stage II diastolic dysfunction (“Pseudonormal”)

0.75 <  E/A < 1.5 and any one of the following:
AR > 0.35
ARdur > Adur + 30 msec
E/A reversal with Valsalva maneuver
Vp < 45 (Vp < 55 if less than 30 y.o.) or E/Vp > 1.5
E/Ea > 10
( 140 < DT (msec) < 220)
(S < D)
Elevated LV filling pressures

 

Stage III diastolic dysfunction (“Reversible Restrictive”)

E/A > 1.5 and
E/A reversal with Valsalva maneuver
E/Ea > 10
Vp < 45 (Vp < 55 if less than 30 y.o.) or E/Vp > 1.5
AR > 0.35
ARdur > Adur + 30 msec
(DT < 150 msec)
(S < D)
Elevated LV filling pressures

 

Stage IV diastolic dysfunction (“Fixed Restrictive”)

E/A > 1.5 and
No E/A reversal with Valsalva maneuver
E/Ea > 10
Vp < 45 (Vp < 55 if less than 30 y.o.) or E/Vp > 1.5
AR > 0.35
ARdur > Adur + 30 msec
(DT < 150 msec)
(S < D)
Elevated LV filling pressures