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Appendix C: Diastolic Function

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    AMA Citation
    Diastolic Function. In: Mathew JP, Nicoara A, Ayoub CM, Swaminathan M. Mathew J.P., Nicoara A, Ayoub C.M., Swaminathan M Eds. Joseph P. Mathew, et al.eds. Clinical Manual and Review of Transesophageal Echocardiography, 3e New York, NY: McGraw-Hill; . http://accessanesthesiology.mhmedical.com/content.aspx?bookid=2499&sectionid=201985698. Accessed July 21, 2019.
    MLA Citation
    . "Diastolic Function." Clinical Manual and Review of Transesophageal Echocardiography, 3e Mathew JP, Nicoara A, Ayoub CM, Swaminathan M. Mathew J.P., Nicoara A, Ayoub C.M., Swaminathan M Eds. Joseph P. Mathew, et al. New York, NY: McGraw-Hill, , http://accessanesthesiology.mhmedical.com/content.aspx?bookid=2499&sectionid=201985698.

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CLASSIFICATION OF DIFFERENT STAGES OF DIASTOLIC DYSFUNCTION

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Normal Impaired Relaxation Pseudonormal Restrictive Filling
TMF
E/A ≥0.8 ≤0.8 0.8–2 ≥2
DT (ms) 150–220 >200 150–220 <160
IVRT (ms) 60–100 >100 60–100 <60
PVF
PV-S/PV-D >1 >1 <1 <1
PV-AR (cm/s) <35 <35 >35 >35
ARdur-Adur (ms) <30 <30 >30 >30
Vp (cm/s) >55 <45 <45 <45
E' (cm/s) >8 (septal) >8 (septal) <8 (septal) <8 (septal)
>10 (lateral) >10 (lateral) <10 (lateral) <10 (lateral)
Average* E/E' <10 <10 10–14 >14

*Average of septal and lateral velocities.

Abbreviations: TMF, transmitral flow; E, early filling peak velocity; A, atrial contraction peak velocity; DT, deceleration time of E wave; IVRT, isovolumic relaxation time; PV-S, peak velocity of systolic component; PV-D, peak velocity of diastolic component; PV-AR, peak velocity of atrial reversal flow; PV-ARdur, duration of atrial reversal flow; Adur, duration of A wave; PVF, pulmonary venous flow; E', early diastolic velocity of the mitral annulus by tissue Doppler imaging; Vp, propagation velocity.

ALGORITHM FOR GRADING DIASTOLIC DYSFUNCTION

FIGURE

(A) Algorithm for diagnosis of left ventricular (LV) diastolic dysfunction. LV diastolic function is normal if more than half of the available parameters do not meet the cutoff values for identifying abnormal function. LV diastolic dysfunction is present if more than half of the available parameters meet these cutoff values. The study is inconclusive if half of the parameters do not meet the cutoff values (B) Algorithm for estimation of LV filling pressures and grading LV diastolic function in patients with diastolic dysfunction. (Modified with permission from Nagueh SF, Smiseth OA, Appleton CP, et al: Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging, J Am Soc Echocardiogr 2016 Apr;29(4):277–314.)

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EFFECT OF AGE ON DOPPLER-DERIVED DIASTOLIC MEASUREMENTS

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Age Group (years)
Doppler Parameter Measurement <20 21–60* >60
Transmitral low IVRT (ms) 50 ± 9 67–74 87 ± 7
E/A ratio 1.9 ± 0.5 1.5–1.3 1.0 ± 0.2
DT (ms) 142 ± 19 166–181 200 ± 29
A dur (ms) 113 ± 17 127–133 138 ± 19
Pulmonary vein flow S/D ratio 0.8 ± 0.18 1.0–1.2 1.4 ± 0.5
Ar (cm/s) 16 ± 10 21–23 25 ± 9
Ar dur (ms) 66 ± 39 96–112 113 ± 30
Lateral annulus tissue velocity E′ (cm/s) 21 ± 3.8 20–16 13 ± 3.5
E′/A′ ratio 3.1 1.9–1.5 0.9 ± 0.4

Values are expressed as mean ± standard deviation.

*For the age group 21–60, values are expressed as range of means.

Abbreviations: A', late lateral annulus tissue velocity; A, late transmitral velocity; Ar, pulmonary venous atrial reversal velocity; D, pulmonary venous diastolic velocity; DT, deceleration time; dur...

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