Table 1.
Echocardiographic variables used to assess diastolic dysfunction and their association with invasive haemodynamic measurements
| Variable of diastolic dysfunction | Background physiology | Dependent physiology | Surrogate measure | Evidence, calculations, and strength of correlation with surrogate measures |
|---|---|---|---|---|
| Peak E-wave velocity | Reflects the pressure gradient between the LA and LV after mitral valve opening during ‘early’ diastole, specifically the ‘rapid-filling’ phase | MV function, LA pressure and compliance, LV volume status (load), and LV relaxation | PCWP |
R = 0.62 [77] R = 0.68 [78] R = 0.86 [79] R = 0.57 [80] |
| Tau | No correlation demonstrated [81] | |||
| Peak A-wave velocity | Reflects the pressure gradient between the LA and LV during atrial contraction | LV relaxation and compliance (i.e. LA afterload), LA pressure, LA contractile function, and LA compliance | LVEDP | R = 0.85 (N.B. change in A-wave velocity with Valsalva) [82] |
| PCWP |
R = − 0.16 [77] R = 0.47 [79] |
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| MV Deceleration time | Reflects the equalising of pressure between the LA and LV resulting in deceleration of ‘early’ MV flow | MV function, LV relaxation, LV chamber compliance and stiffness | PCWP |
R = − 0.61 [83] R = − 0.55 [79] R = − 0.36 [80] R = − 0.07 [77] |
| LVEDP |
R = − 0.48 [83] R = 0.30 [84] |
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| LV chamber stiffness (b) |
R = 0.39 [84] R = − 0.81 [85] |
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| LV stiffness constant (β) | R = 0.09 [84] | |||
| LAP (direct) | R = − 0.73 [20] | |||
| Tau |
R = 0.28 [84] No correlation demonstrated [81] |
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| Pre-A-wave-LVDP | R = − 0.39 [86] | |||
| MV E/A ratio | Non-physiological (a method for identifying descriptive ‘filling patterns’, i.e. normal, impaired relaxation, pseudonormalisation, restrictive) | (As for peak E-wave and peak A-wave velocity) | LAP (direct) | R = 0.49 [20] |
| mLVDP | R = 0.59 [18] | |||
| LVEDP |
R = − 0.04 [84] No correlation reported [82] |
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| PCWP |
R = 0.42 [79] R = 0.46 [80] R = 0.52 [77] R = 0.63 [83] |
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| Tau |
R = − 0.46 [87] R = − 0.36 [84] |
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| LV chamber stiffness (b) | R = − 0.24 [84] | |||
| LV stiffness constant (β) | R = − 0.22 [84] | |||
| TDI eʹ velocity | Reflects myocardial fibre lengthening during LV relaxation as a measurement of MV annular motion during early diastole | LV relaxation, elastic restoring forces, and load | PCWP |
R = − 0.37 [80] R = 0.13 [78] R = 0.81 (N.B. medial annulus) [79] |
| mLVDP | R = 0.36 (N.B. medial annulus) [18] | |||
| Tau |
R = − 0.81 (N.B. lateral annulus) [81] R = − 0.70 [12] R = − 0.56 [87] R = − 0.51 [88] R = − 0.46 [18] R = − 0.33 [84] |
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| LVEDP |
R = − 0.50 [84] R = 0.61 [88] |
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| LV chamber stiffness (b) | R = − 0.39 [84] | |||
| LV stiffness constant (β) | R = − 0.41 [84] | |||
| TDI E/eʹ ratio | Non-physiological (peak E-wave velocity corrected for the influence of myocardial relaxation by dividing by TDI eʹ velocity) | As per peak E-wave velocity and TDI eʹ velocity | PCWP |
R = 0.17 (N.B. lateral annulus) [79] R = 0.63 (N.B. medial annulus) [26] R = 0.86; PCWP = [(1.47 × E/eʹ) + 1.55] [80] R = 0.87; PCWP = [(1.24 × E/eʹ) + 1.9] [78] |
| mLVDP | R = 0.64 (N.B. medial annulus) [18] | |||
| pre-A-wave-LVDP | R = 0.74 [86] | |||
| LVEDP |
R = 0.71 [84] R = 0.79 [88] LVEDP = [(0.85 × E/eʹ) + 4.4] [89] |
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| Tau | R = 0.34 [84] | |||
| LV chamber stiffness (b) | R = 0.46; b = [(0.016 × E/eʹ) + 0.1] [84] | |||
| LV stiffness constant (β) | R = 0.53; β = [(0.002 × E/eʹ) + 0.008] [84] | |||
| Peak TR-velocity | Reflects the pressure gradient between the RV and RA during systole | TV function (presence of TR), RA pressure, PA pressure and compliance | Estimated PCWP | R = 0.73 (N.B. correlation with PASP) [90] |
| TR velocity > 2.8 m/s (ASE/EACI criteria for diastolic dysfunction) | A TR velocity cut-off of > 2.8 m/s is based on population studies of upper limits of normal, endorsed by international guidelines [91, 92] | |||
| LA volume index | Reflects chronic LA pressure elevation, manifesting as increased LA volume (indexed for BSA) | LA stiffness, volume status (load), MV function | LA volume index > 34 mL/m2 (ASE/EACI criteria for diastolic dysfunction) | Tsang 2002 et al. [93] defined an LA volume index cut off > 34 mL/m2 as a predictor of E/eʹ > 15 (sensitivity 86%, specificity 66%). ‘Moderate’ LA dilatation defined in ASE 2005 guidelines [94], based on population studies. Described in initial grading system for diastolic dysfunction by Nagueh et al. [95]. Revised in updated ASE 2015 guidelines to define 34mls/m2 as ULN for LA size [96] |
ASE American Society of Echocardiography; BSA body surface area; EACI European Association of Cardiovascular Imaging; LA left atrium; LAP left atrial pressure; LV left ventricle; LVDP left ventricular diastolic pressure; LVEDP left ventricular end-diastolic pressure; mLVDP mean left ventricular diastolic pressure; MV mitral valve; PA pulmonary artery; PASP pulmonary artery systolic pressure; PCWP pulmonary capillary wedge pressure; RA right atrium; RV right ventricle; TDI tissue Doppler imaging; TR pulmonary tricuspid regurgitation; ULN upper limit of normal