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. 2003 Nov;89(Suppl 3):iii18–iii23. doi: 10.1136/heart.89.suppl_3.iii18

A clinical approach to the assessment of left ventricular diastolic function by Doppler echocardiography: update 2003

S Ommen, R Nishimura
PMCID: PMC1876299  PMID: 14594871

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Figure 1.

Figure 1

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The phases of left ventricular filling are relaxation, suction, filling, and atrial contraction as depicted in these simultaneous invasive pressure curves and Doppler echocardiography. A, mitral filling at atrial contraction; Adur, duration of mitral A wave; DT, mitral deceleration time; E, mitral early filling wave; LA, left atrial pressure curve; LV, left ventricular pressure curve.

Figure 2.

Figure 2

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The progression of left ventricular diastolic dysfunction can be readily assessed using a combination of Doppler echocardiographic variables. Each successive grade represents a worsening state of diastolic dysfunction. LAp, left atrial pressure; MVI, mitral valve inflow; TDI, tissue Doppler imaging; Valsalva, response of mitral valve inflow to Valsalva manoeuvre; Vp, mitral inflow propagation velocity.

Figure 3.

Figure 3

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Relation between mitral deceleration time and left atrial pressure as assessed from three separate simultaneous Doppler catheterisation studies. EF, left ventricular ejection fraction; LA, left atrial. Adapted from Nishimura et al,6, Ommen et al,7 and Yamamoto et al.13

Figure 4.

Figure 4

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Relation between systolic and diastolic function and overall survival highlights the critical role of diastolic function for the prognosis of patients with impaired left ventricular systolic function. DT, Deceleration time; EF, ejection fraction. Reproduced from Rihal et al,8 with permission.

Figure 5.

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The response of the mitral inflow to preload manipulation can be useful in predicting filling pressures. On the left is a normal response to the Valsalva manoeuvre with proportional decreases in both mitral E and A waves in a patient with normal filling pressures. On the right, the Valsalva manoeuvre results in disproportionate decrease in mitral E wave in a patient with raised filling pressure. A decrease in the mitral E/A ratio of 0.5 or more is a highly specific indicator of increased filling pressures. A, mitral filling at atrial contraction; E, mitral early filling wave; LVEDP, left ventricular end diastolic pressure; m/s, metres per second.

Figure 6.

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The duration of flow at atrial contraction into the left ventricle as compared to duration of flow reversal into the pulmonary veins can indicate end diastolic filling pressure. In this example, flow duration is much longer on the pulmonary vein Doppler signal (180 ms v 150 ms) indicating raised left ventricular end diastolic pressure. A, mitral filling at atrial contraction; E, mitral early filling wave; LVEDP, left ventricular end diastolic pressure; PVa dur, pulmonary vein atrial reversal duration; PVd, pulmonary vein diastolic forward flow, PVs, pulmonary vein systolic forward flow.

Figure 7.

Figure 7

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The tissue Doppler velocity of the mitral annulus can help distinguish between normal and abnormal filling. These examples are from two patients with normal systolic function and similar mitral inflow signals. On the left, a normal mitral annular velocity and E/e' ratio indicate normal filling pressures. On the right, the mitral annular e' velocity is reduced and the E/e' ratio elevated in a patient with high left atrial pressure. A, mitral filling at atrial contraction; a', late mitral annulus diastolic velocity; E, mitral early filling wave; e', early mitral annulus diastolic velocity; E/e', ratio of mitral early filling wave to early mitral annulus velocity; LA p, left atrial pressure.

Figure 8.

Figure 8

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Cut-off values using the ratio of mitral early filling wave to early mitral annulus velocity (E/e') can be used to group patients according to filling pressures. Those with high ratios (> 15) have high filling pressures, while those with very low ratios tend to have normal filling pressures. The intermediate group requires additional information to correctly classify diastolic function. The closed circles represent those patients with other Doppler parameters suggesting high filling pressures. Reproduced from Ommen et al,7 with permission.

Figure 9.

Figure 9

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Screening assessment for diastolic function and filling pressures. Two dimensional and Doppler echocardiographic variables can be used to readily classify diastolic function. *In general, high filling pressures should be confirmed with multiple parameters (that is, E/e', E/Vp, A-dur difference, response to Valsalva manoeuvre, TR velocity, etc).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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