Table 1 Four main parameters used to define left ventricular diastolic dysfunction and their cutoffs
Parameter | Abnormal value | Mode of measurement | Limitation/confounders |
|---|---|---|---|
TR jet velocity | > 2.8 m/s | Parasternal and apical 4-ch view with CFD to get highest velocity aligned with CWD. Adjust gain and contrast to display complete spectral envelope (no signal spikes or feathering) Analysis: peak modal velocity during systole at leading edge of spectral waveform | Indirect estimate of LA pressure; adequate recording of full envelope not always possible; in some cases accuracy of calculation is dependent on reliable estimation of right atrial systolic pressure |
LA volume | > 34 mL/m2 | Apical 4-ch and 2-ch: acquire freeze frames (1-2 frames before MV opening). LA volume measured in dedicated views (length and transverse diameters maximized) Analysis: method of disks or area-length method; correct for body surface area. Do not include LA appendage or pulmonary veins in tracings | LA dilatation is seen in bradycardia, high-output states, heart transplants, atrial flutter/fibrillation, significant MV disease, despite normal LV diastolic function; LA dilatation occurs in well-trained athletes; suboptimal image quality (i.e., foreshortening) precludes accurate tracings; it can be difficult to quantify in patients with aortic aneurysms or in patients with large inter-atrial septal aneurysms |
e′ | Septal < 7 cm/s Lateral < 10 cm/s | Apical 4-ch view: PWD sample volume (usually 5–10 mm axial size) at lateral or septal basal regions. Use ultrasound system presets for wall filter and lowest signal gain. Optimal spectral waveforms should be sharp (no signal spikes, feathering or ghosting) Analysis: peak modal velocity in early diastole at the leading edge of spectral waveform | Limited accuracy in patients with CAD and RWMAs, significant MAC, surgical rings or prosthetic MV, pericardial disease; need to sample at least two sites; different cutoffs depending on sampling site; age dependent (decreases with aging) |
E/e′ ratio | Average > 14 Septal > 15 Lateral > 13 | E wave: apical 4-ch with CFD imaging for optimal alignment of PWD with blood flow. PWD sample volume (1–3 mm axial size) between mitral leaflet tips. Use low wall filter setting (100–200 MHz) and low signal gain. Optimal spectral waveforms should not display spikes or feathering Analysis: peak modal velocity in early diastole at the leading edge of spectral waveform e′: see above Analysis: E velocity divided by e′ velocity | Not accurate in normal subjects, patients with MAC, pericardial disease; “gray zone” of values in which LV filling pressures are indeterminate; accuracy reduced in CAD and RWMAs; different cutoff values depending on the site used for measurement |