diastolic dysfunction by echocardiography

1. ECHOCARDIOGRAPHIC EVALUATION
OF DIASTOLIC DYSFUNCTION
Dr Anup Pusate

2. Normal diastolic function
• Following isovolumetric relaxation , mitral
valve opens and most filling occurs in first 1/3
of diastole as result of elastic recoil

3. • Mitral valve inflow velocity reveals E/A ratio of 0.9 with a corresponding
reversal of the annular e’/a’ ratio, consistent with grade 1 diastolic
dysfunction.

4. • “Normal” mitral valve E/A ratio but the reversed pattern of the
annular velocities suggesting pseudonormal filling or grade 2
diastolic dysfunction.

5. • Poorly treated hypertension who has developed systolic dysfunction. Mitral
valve inflow velocity pattern reveals a short deceleration time of 110 ms
and there are reduced annular velocities, all consistent with grade 3
diastolic dysfunction.

6. • Marked ventricular hypertrophy characteristic of amyloid. Annular Doppler
tissue image revealing a pathologically reduced annular E/A ratio with an
annular E velocity of 4 cm/sec, more in line with infiltrative than
hypertrophic process.

7. • Reversal of mitral E/A ratio, which is paralleled by reversal of
annular velocities, all consistent with grade 1 diastolic dysfunction.

8. • Diabetic patient. Pseudonormal mitral inflow with a mitral inflow E/A ratio
of approximately 1.2, but reversed annular e’/a’ ratio of both septal and
lateral mitral annulus implying diastolic dysfunction.