From the Guidelines
Grading diastolic dysfunction on transesophageal echocardiography (TEE) involves evaluating several key parameters, including mitral inflow patterns, tissue Doppler imaging of the mitral annulus, and pulmonary vein flow patterns, with the most recent guidelines 1 providing a framework for assessment.
Key Parameters for Grading Diastolic Dysfunction
- Mitral inflow patterns using pulsed-wave Doppler to measure the E/A ratio
- Tissue Doppler imaging of the mitral annulus to obtain e' velocities and calculate the E/e' ratio
- Deceleration time of the E wave
- Pulmonary vein flow patterns
Grading Scheme
- Grade 1 (mild) diastolic dysfunction: E/A ratio <0.8, deceleration time >200 ms, and E/e' <10
- Grade 2 (moderate) diastolic dysfunction: E/A ratio between 0.8-2.0, deceleration time 160-200 ms, and E/e' between 10-14
- Grade 3 (severe) diastolic dysfunction: E/A ratio >2.0, deceleration time <160 ms, and E/e' >14
Additional Considerations
- Left atrial enlargement supports the diagnosis of diastolic dysfunction
- Clinical context and loading conditions should be considered when interpreting these parameters
- TEE offers excellent visualization of these parameters due to its proximity to cardiac structures, with the grading scheme being fundamentally the same as in transthoracic echocardiography, as noted in 1.
From the Research
Diastolic Dysfunction Grading on Transesophageal Echocardiography (TEE)
- Diastolic dysfunction can be graded using various parameters on TEE, including mitral inflow velocity, deceleration time, isovolumic relaxation time, and tissue Doppler imaging 2, 3, 4.
- Tissue Doppler imaging can assess the mitral annulus motion, providing information about left ventricular diastolic function 3, 4.
- The peak early diastolic mitral annulus velocity (E') and the E'/A' ratio can be used to identify pseudonormalization, with a sensitivity of 77% and a specificity of 88% when E' < 7 cm/s and E'/A' < 1 4.
- The combination of mitral E/A ratio > 1 with left ventricular end-diastolic pressure (LVEDP) > or = 15 mmHg can be used to classify pseudonormalization 4.
- Emerging imaging techniques, such as cardiac magnetic resonance imaging (CMRI), can also be used to assess diastolic dysfunction, providing additional information about the underlying cause and pathophysiology 5.
- Doppler echocardiography, including mitral inflow velocity, pulmonary venous flow velocity, and mitral annulus velocity measured by tissue Doppler imaging, is a useful tool for diagnosing left ventricular diastolic dysfunction 6.