• The application of the guidelines starts with taking note of the clinical data, heart rate, blood pressure, 2D and Doppler findings with respect to LV volumes/wall thickness, ejection fraction (EF), LA volume, presence and severity of mitral valve disease as well as the underlying rhythm. The guidelines are not necessarily applicable to children or in the perioperative setting.
• The quality of the Doppler signal as well as the limitations for each parameter should be carefully examined. If a Doppler signal is suboptimal, that signal should not be used in formulating conclusions about LV diastolic function
• The presence of a single measurement that falls within the normal range for a given age group does not necessarily indicate normal diastolic function. Given the several hemodynamic factors that affect each signal, some measurements may fall in the normal range despite the presence of diastolic dysfunction, and none of the indices should be used in isolation. Therefore, consistency between two or more of the indices should be relied upon in an individual patient.
• The echocardiographic indices of diastolic function should always be interpreted in a wider context that includes clinical status and the other 2D and other Doppler parameters. Although often overlooked in reporting, the underlying pathology shown by 2D and color Doppler is critical to reaching the correct conclusions about LV diastolic function.
• With respect to the grading of LV diastolic dysfunction, it is the recommendation of the writing group to determine the grade of diastolic function based on the presence or absence of elevated LV filling pressures as a first step.
• Notwithstanding this effort, the algorithms are not 100% accurate. For the most successful application of the guidelines, it is incumbent on the echocardiographer to have a solid understanding of the physiologic rationale behind each variable, the situations that make any given variable less reliable, and the technical aspects and acquisition and analysis of Doppler and 2D signals.