| LV relaxation, filling pressures and 2D and Doppler findings according to LV diastolic function | ||||
|---|---|---|---|---|
| AF | ||||
| Peak acceleration rate of mitral E velocity (≥1,900 cm/sec2) IVRT (≤65 msec) DT of pulmonary venous diastolic velocity (≤220 msec) E/Vp ratio (≥1.4) Septal E/e' ratio (≥11) | ||||
| Sinus tachycardia | ||||
| Mitral inflow pattern with predominant early LV filling in patients with EFs < 50% IVRT ≤70 msec is specific (79%) Pulmonary vein systolic filling fraction ≤40% is specific (88%) Average E/e' >14 (this cutoff has highest specificity but low sensitivity) When E and A velocities are partially or completely fused, the presence of a compensatory period after premature beats often leads to separation of E and A velocities which can be used for assessment of diastolic function | ||||
| HCM | ||||
| Average E/e' (>14) Ar-A (≥30 msec) TR peak velocity (>2.8 m/sec) LA volume (>34 mL/m2). | ||||
| Restrictive cardiomyopathy | ||||
| DT (< 140 msec) Mitral E/A (>2.5) IVRT (< 50 msec has high specificity) Average E/e' (>14) | ||||
| Noncardiac pulmonary hypertension | ||||
| Lateral E/e' can be applied to determine whether a cardiac etiology is the underlying reason for the increased pulmonary artery pressures When cardiac etiology is present, lateral E/e' is >13, whereas in patients with pulmonary hypertension due to a noncardiac etiology, lateral E/e' is < 8 | ||||
| Mitral stenosis | ||||
| IVRT (< 60 msec has high specificity) IVRT/TE-e' (< 4.2) Mitral A velocity (>1.5 m/sec) | ||||
| MR | ||||
| Ar-A (≥30 msec) IVRT (< 60 msec has high specificity) IVRT/TE-e' (< 5.6) may be applied for the prediction of LV filling pressures in patients with MR and normal EFs Average E/e' (>14) may be considered only in patients with depressed EFs | ||||
A comprehensive approach is recommended in all of the above settings, which includes estimation of PASP using peak velocity of TR jet (>2.8 m/ sec) and LA maximum volume index (>34 mL/m2). Conclusions should not be based on single measurements. Specificity comments refer to predicting filling pressures > 15 mmHg. Note that the role of LA maximum volume index to draw inferences on LAP is limited in athletes, patients with AF, and/or those with mitral valve disease.