LV Diastolic Function & LA Pressure

BSE reference tables

Thresholds & inflow patterns

Diastolic function — abnormal thresholds (ASE/EACVI, used by BSE)

Four key variables for assessing LV filling pressure (ASE/EACVI 2016). If >half of the available variables are abnormal, filling pressures are raised.

Diastolic function — abnormal thresholds
ParameterAbnormal cut-off
Septal e' (cm/s)<7
Lateral e' (cm/s)<10
Average E/e'>14
Septal E/e'>15
Lateral E/e'>13
LA volume index (mL/m²)>34
Peak TR velocity (m/s)>2.8

BSE 2024 update: average e' ≤6.5 cm/s (septal ≤6, lateral ≤7), average E/e' >14, E/A ≤0.8 or ≥2, LAVi >34 mL/m², and LA reservoir strain ≤18% support elevated filling pressure.

Mitral inflow (E/A) patterns and grades of diastolic dysfunction

Mitral inflow patterns with E/A ratio and deceleration time (DT).

E/A patterns / diastolic dysfunction grades
PatternE/ADT (ms)
Normal0.8–2150–220
Impaired relaxation (Grade 1)≤0.8>220
Pseudonormal (Grade 2)0.8–2150–200
Restrictive (Grade 3)≥2<150

TextbookNagueh et al. Recommendations for the evaluation of LV diastolic function. ASE/EACVI. J Am Soc Echocardiogr 2016.

Revision flashcards

Diastolic function — flashcards

Four key variables for raised LV filling pressure?

Markers of raised LV filling pressure (>half abnormal)
Average E/e'>14ratio
Septal e'<7cm/s
Lateral e'<10cm/s
Peak TR velocity>2.8m/s
LA volume index>34mL/m²

TextbookNagueh et al. Recommendations for the evaluation of LV diastolic function. ASE/EACVI. J Am Soc Echocardiogr 2016.

Grades of diastolic dysfunction by E/A and DT?

Diastolic dysfunction grades
GradeE/ADT (ms)
Normal0.8–2150–220
1 — impaired relaxation≤0.8>220
2 — pseudonormal0.8–2150–200
3 — restrictive≥2<150

TextbookNagueh et al. Recommendations for the evaluation of LV diastolic function. ASE/EACVI. J Am Soc Echocardiogr 2016.