1. In patients with reduced LVEFs, transmitral inflow pattern is usually sufficient to identify patients with increased LAP and DT of mitral E velocity is an important predictor of outcome.
2. In patients with preserved LVEFs, several parameters, including 2D variables, are often needed to estimate LAP.
3. In patients with depressed EFs and in patients with normal EFs and myocardial disease, if E/A ratio is <= 0.8 along with a peak E velocity of <= 50 cm/sec, then mean LAP is either normal or low and patient has grade I diastolic dysfunction.
4. In patients with depressed EFs and in patients with normal EFs and myocardial disease, if E/A ratio is >= 2, LA mean pressure is elevated and grade III diastolic dysfunction is present. DT is usually short in patients with HFrEF and restrictive filling pattern (< 160 msec). However, in patients with HFpEF, DT can be normal despite elevated LV filling pressures.
5. In patients with depressed EFs and in patients with normal EFs and myocardial disease, E/A ratio <= 0.8 along with a peak E velocity of > 50 cm/sec, or an E/A ratio > 0.8 but < 2, additional parameters are needed. These include peak TR velocity, E/e’ ratio and LA maximum volume index. Their cutoff values to conclude elevated LAP are peak velocity of TR jet > 2.8 m/sec, average E/e’ ratio > 14, and LA maximum volume index > 34 mL/m². If more than half or all of the variables meet the cutoff values, then LAP is elevated and grade II diastolic dysfunction is present. If only one of three available variables meets the cutoff value, then LAP is normal and grade I diastolic dysfunction is present. In case of 50% discordance or with only one available variable, findings are inconclusive to estimate LAP.
6. In patients with depressed LVEFs, pulmonary vein S/D ratio may be used if one of the three main parameters is not available. A ratio < 1 is consistent with increased LAP.