#0/7 Thanks @purviparwani for robust discussion on diastology which means "Dilation".
I was asked to present my approach to Diastolic Function assessment at @ase360 " Just Relax: Diastolic Dysfunction" session. Let me share again and explain the 7 points that I emphasized.
I was asked to present my approach to Diastolic Function assessment at @ase360 " Just Relax: Diastolic Dysfunction" session. Let me share again and explain the 7 points that I emphasized.
#1/7 As the session title indicates, good LV relaxation is key to normal diastolic function. Simply, if relaxation by e' is abnormal, DF is abnormal. If relaxation, e', is normal, DF is NL as in 80 yo below . Mitral e' is the best Echo measure of relaxation,Noninvasive Tau.
#2/7 Not all DF and filling pressure assessment requires all 4 parameters. Sometimes, 1 or 2 (usually mitral inflow and annulus velocity) parameters are sufficient (Figure). Others may require >4, even exercise. There is also hierarchical strength among DF parameters.@aae_echo
#3/7 Grade 1 dysfunction is common in the elderly. It indicates normal FP at rest, but has a potential to increase FP with exercise. Grade 1 dysfunction or "reduced diastolic reserve" with normal FP at rest can be diagnosed by mitral inflow alone. See simultaneous Echo and cath.
#4/7. In most patients, I use medial or septal e' velocity rather than averaging unless there is >30% difference between medial and lateral e' as shown in figure from LBBB patient. This patient has normal FP. Lateral e' is about 25% higher than medial e' in normal setting.
#5/7. I do not adjudicate diastolic dysfunction(DD)based on LVEF or clinical history although it is important for overall interpretation. DD should be based on reduced relaxation and increased FP by Doppler. Young pts can maintain normal DF or FP despite low EF,MI, LVH (Figure)
#6/7. E/e' >=15 is specific for increased FP, but not sensitive. We need to consider high FP when E/e'>10 esp with TR> 2.8 m/sec.
E/e' does not work well in mitral annulus calcification. Use mitral E/A, IVRT,PV, and LA strain. In HCM, E/e' >15 is sensitive, but not specific.
E/e' does not work well in mitral annulus calcification. Use mitral E/A, IVRT,PV, and LA strain. In HCM, E/e' >15 is sensitive, but not specific.
#7/7. Clinically, most important data is mean diastolic or LA pressure. Echo can do this in most pts including critical care setting if we understand what determines Doppler variables. We also have pr ECG AI and Echo AI to help determine Diastolic FP in future. Exciting!!!
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