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Clinical Manual and Review of Transesophageal Echocardiography, 2e

Appendix C. Diastolic Function

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Normal

Impaired Relaxation

Pseudonormal

Restrictive Filling

TMF

E/A

1-2

<0.8

0.8-1.5

≥2

DT (ms)

150-220

>200

150-220

<160

IVRT (ms)

60-100

>100

<60

PVF

PV-S/PV-D

PV-AR (cm/s)

<35

>35

ARdur–Adur

<30

>30

>55

<45

E′

>8 (septal)

<8 (septal)

>10 (lateral)

<10 (lateral)

E/E′

<8 (septal)

≤8 (septal)

9-12

>15 (septal)

<8 (lateral)

≤8 (lateral)

(average)a

>12 (lateral)

a Average of septal and lateral velocities. TMF, transmitral flow; E, early filling peak velocity; A, late-filling 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′, peak tissue velocity in early diastole; Vp, velocity of propagation.

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Age Group (years)

Doppler Parameter

Measurement

<20

21-60a

>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. aFor the age group 21-60, values are expressed as range of means. 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, duration; E′, early lateral annulus tissue velocity; E, early transmitral velocity; IVRT, isovolumic relaxation time; ms, milliseconds; S, pulmonary venous systolic velocity.

1. Nagueh SF, Appleton CP, Gillebert TC, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr. 2009;22:107-133. [PubMed: 19187853]

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