Thursday, 21 July 2016

Echo assessment of LV diastolic function

Assessing left ventricular diastolic function can get complicated. However, things were made a bit easier recently with the publication of some new joint ASE/EACVI guidelines on the echo evaluation of LV diastolic function. The guidelines are detailed (they're almost 40 pages long), but the principal take home message can be summarized as follows:

Echo diagnosis of LV diastolic dysfunction

The guidelines recommend measuring four key parameters to assess LV diastolic function:

Annular e' velocity
An abnormal e' velocity is indicated by a septal e' <7 cm/s, or a lateral e' <10 cm/s.

Average E/e' ratio
The authors recommend that an average E/e' ratio is used (rather than separate septal and lateral E/e' ratios), and that the average E/e' ratio is considered to be abnormal if it is >14. If an average can't be calculated, then a lateral E/e' >13, or a septal E/e' >15, is considered to be abnormal.

Left atrial volume index
The left atrial maximum volume index is abnormal if it is >34 mL/m2.

Peak tricuspid regurgitation velocity
This is abnormal if peak TR velocity is >2.8 m/s.

Judging whether LV diastolic function is normal or abnormal depends upon how many of the measured parameters are abnormal:
  • If more than 50% of the measured variables are abnormal, then LV diastolic function is abnormal
  • If less than 50% of the measured variables are abnormal, then LV diastolic function is normal
  • If 50% of the measured variables are abnormal, then LV diastolic function is indeterminate
This method of using the majority of available parameters to make an overall judgement about LV diastolic function is useful, as it allows a conclusion to be made about diastolic function even if all four parameters aren't available.

The guidelines can be found by clicking here, and are well worth reading. As well as giving overall advice about the echo assessment of LV diastolic function, they also contain guidance on assessing diastolic function in specific situations (such as atrial fibrillation and hypertrophic cardiomyopathy).

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