Figure 2.

Proposition for a simplified diagnostic algorithm regarding the contribution of tissue Doppler echocardiography to the diagnosis of chronic heart failure with preserved left ventricular systolic function (stage C of the ACC/AHA classification) in patients presenting with exertional dyspnea, after excluding overt myocardial ischemia, significant valvular disease and arrhythmias; adapted from the references [9,67,76-78,88]. E: peak E mitral velocity; E': spectral tissue Doppler peak early diastolic velocity at the septal side of mitral annulus; LV: left ventricular. The use of a cut-off value of 13 would reinforce the positive predictive value but would lack the negative predictive value.