From the Guidelines
The American Society of Echocardiography (ASE) criteria for Grade 1 diastolic dysfunction include an E/A ratio ≤ 0.8 along with a peak E velocity of ≤50 cm/sec, indicating impaired relaxation without increased filling pressures. The key diagnostic criteria for Grade 1 diastolic dysfunction, as outlined in the ASE guidelines 1, 2, involve assessing left ventricular relaxation and filling pressures through various echocardiographic parameters.
Key Parameters
- E/A ratio ≤ 0.8
- Peak E velocity ≤ 50 cm/sec
- Additional parameters such as peak TR velocity, E/e′ ratio, and LA maximum volume index may be used to further evaluate diastolic function when the E/A ratio and peak E velocity are not conclusive 2.
Clinical Context
Grade 1 diastolic dysfunction is often seen in conditions such as aging hearts, hypertension, left ventricular hypertrophy, and early stages of various cardiomyopathies 1, 3. It is characterized by impaired relaxation without increased filling pressures, which can lead to symptoms during exercise due to decreased diastolic filling time 4.
Diagnostic Approach
The ASE guidelines recommend a stepwise approach to evaluating diastolic function, starting with the assessment of mitral inflow patterns and then incorporating additional parameters as needed to estimate left atrial pressure and grade diastolic dysfunction 2, 5.
Parameters for Estimating LAP
- Peak TR velocity > 2.8 m/sec
- Average E/e′ ratio > 14
- LA maximum volume index > 34 mL/m² If more than half of these parameters meet the cutoff values, LAP is considered elevated, indicating Grade II diastolic dysfunction; if less than half meet the cutoff values, LAP is considered normal, indicating Grade I diastolic dysfunction 3.
From the Research
ASE Criteria for Grade 1 Diastolic Dysfunction
The American Society of Echocardiography (ASE) criteria for diastolic dysfunction are based on echocardiographic variables. According to the 2016 ASE/European Association of Cardiovascular Imaging (EACVI) recommendations, diastolic function is assessed using the following parameters:
- Left atrial volume index (LAVI) > 34 ml/m2
- Tricuspid regurgitation (TR) velocity > 2.8 m/sec
- Septal e' < 7 cm/sec
- Septal E/e' ratio > 15
Grade 1 Diastolic Dysfunction
Grade 1 diastolic dysfunction is characterized by:
- Abnormal relaxation with normal filling pressures
- E/A ratio < 0.8 (indicating impaired relaxation)
- E/e' ratio < 8 (indicating normal filling pressures)
- LAVI may be normal or mildly elevated
The ASE criteria for Grade 1 diastolic dysfunction are not explicitly stated in the provided studies, but based on the recommendations, it can be inferred that Grade 1 diastolic dysfunction would be characterized by mild abnormalities in diastolic function, such as a mildly elevated LAVI or a slightly impaired E/A ratio 6, 7, 8.
Key Points
- The ASE criteria for diastolic dysfunction are based on echocardiographic variables, including LAVI, TR velocity, septal e', and septal E/e' ratio.
- Grade 1 diastolic dysfunction is characterized by abnormal relaxation with normal filling pressures.
- The ASE criteria for Grade 1 diastolic dysfunction are not explicitly stated, but can be inferred based on the recommendations 6, 7, 8.