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. 2020 Jan 14;10:919. doi: 10.3389/fendo.2019.00919

Figure 1.

Figure 1

Echocardiographic hallmarks in the spectrum of diastolic dysfunction. (A) Schematic long-axis, sagittal view of the left atrium and left ventricle showing transmitral Doppler filling (black arrow) and septal and lateral mitral annular motion (small green arrow within LV wall) during early diastole. (B) Graphic representation of early and late transmitral Doppler-derived wave patterns in relation to the electrocardiogram (EKG). (C) Graphic representation of early and late tissue Doppler-derived mitral annular wave patterns. (Left) Normal diastolic function. The majority (80%) of left ventricular (LV) filling occurs during the early phase of diastole, as depicted by a relatively long black arrow extending from the mitral leaflets into the LV apex. The longer the arrow, the higher the relative velocity of early filling, or E wave, compared with late filling (A wave). Normally, E velocity is equal to or greater than A velocity. (Middle) Impaired relaxation or stage I diastolic dysfunction. With aging, mild hypertension or pressure overload, and/or ischemia, early filling (E wave) is impaired or reduced as depicted by a shorter extension of the black arrow into the LV apex. Also, late filling (A wave) is increased, due to a more vigorous atrial contraction to partly compensate and augment ventricular volume. The ratio of early-to-late-filling velocity is <1, or E < A, in this stage of diastolic dysfunction. Also, septal and lateral mitral annular velocities (e′) are reduced when compared with “normal” (green arrow). (Right) Pseudonormal pattern or Stage II diastolic dysfunction. With progressive worsening of diastolic dysfunction, LA size, and pressure increase. Because the LA functions as a reservoir to help maintain an appropriate atrioventricular pressure gradient during diastole, this increase in LA pressure (LAP) helps load blood into the non-compliant LV. With progressive worsening of diastolic dysfunction, LA size, and pressure increase. While the transmitral flow velocity profile appears normal, the mitral annular motion, or e′, remains reduced. In this situation, the mitral inflow profile is termed “pseudonormal”.