Interpretation of Diastolic Doppler Measurements
Yes, a cardiologist can definitively interpret these measurements, which indicate Grade I diastolic dysfunction (impaired relaxation pattern) with normal left ventricular filling pressures. 1
Analysis of Your Specific Values
E/A Ratio of 0.69
- This confirms Grade I diastolic dysfunction, falling below the diagnostic threshold of ≤0.8 that defines impaired relaxation. 1, 2
- The normal range for E/A ratio varies by age: 0.73-2.33 (ages 21-40), 0.78-1.78 (ages 41-60), and 0.6-1.32 (>60 years). 1
- Your value indicates delayed left ventricular relaxation, the primary abnormality in early diastolic dysfunction, not elevated filling pressures. 2
Tissue Doppler E' Velocities
- Lateral e' of 9.8 cm/s is borderline reduced (normal ≥10 cm/s for ages <60, or ≥5.9 cm/s for ages >60). 1, 3, 4
- Septal e' of 6.5 cm/s is reduced (normal ≥7 cm/s), indicating impaired myocardial relaxation. 1, 3, 4
- The average e' is approximately 8.2 cm/s, which is mildly reduced and consistent with early diastolic dysfunction. 1, 3
E/e' Ratio Calculation
- Using the average e' of 8.2 cm/s, the E/e' ratio would be <8, definitively indicating normal left ventricular filling pressures. 1, 4
- For septal E/e', values <8 are normal and >15 are elevated, with 8-15 being indeterminate. 1
- This is critical: despite having diastolic dysfunction, your filling pressures remain normal. 2, 4
E Wave Deceleration Time of 236 msec
- This is prolonged (normal range 138-194 msec for ages 21-40,143-219 msec for ages 41-60,142-258 msec for >60 years). 1
- Prolonged deceleration time confirms the impaired relaxation pattern and excludes restrictive physiology (which would show DT <160 msec). 1
Clinical Significance in Context of Cardiovascular Risk
Hypertension and Diabetes Connection
- Delayed relaxation occurs characteristically in uncomplicated systemic arterial hypertension, making this pattern expected in hypertensive patients. 1
- The elevated cystatin C mentioned suggests early vascular and renal damage, which correlates with cardiovascular risk factors. 5, 6
- Cystatin C elevation is independently associated with diabetes, hypertension, and decreased glomerular filtration. 6, 7
Prognostic Implications
- Normal in-treatment transmitral flow pattern indicates low risk for heart failure (HR 0.22,95% CI 0.05-0.98). 1
- However, Grade I diastolic dysfunction requires monitoring as it can progress to higher grades with elevated filling pressures. 2
- The combination of reduced e' velocities (particularly septal e' <7 cm/s) warrants attention, though values are not severely reduced (<5 cm/s would indicate advanced dysfunction). 3
Critical Pitfalls to Avoid
Pseudonormalization Risk
- The E/A ratio of 0.69 is too low to represent pseudonormalization (which occurs with E/A 0.8-2.0 and elevated E/e' >14). 2
- In patients with reduced ejection fraction, pseudonormal patterns can masquerade as normal, but your low E/A ratio excludes this. 2
- Valsalva maneuver is unnecessary here given the clearly abnormal E/A ratio. 1, 2
E/e' Ratio Limitations
- Always average septal and lateral e' values for optimal global diastolic function assessment, particularly important with regional dysfunction. 1, 4
- E/e' has limited accuracy with mitral annular calcification, mitral valve disease, pericardial disease, or atrial fibrillation. 4
- The correlation between E/e' and invasively measured filling pressures is only modest (r=0.56). 4
Recommended Clinical Approach
Immediate Assessment
- Confirm left atrial volume index (normal <34 mL/m²) to exclude chronically elevated pressures. 2
- Measure tricuspid regurgitation velocity (normal <2.8 m/sec) to further confirm absence of elevated pressures. 1, 2
- Assess left ventricular mass and geometry to quantify hypertensive heart disease severity. 1
Management Strategy
- Aggressively control hypertension with ACE inhibitors or ARBs to improve ventricular relaxation and promote regression of hypertrophy. 2
- Use beta-blockers to lower heart rate and increase diastolic filling period, particularly beneficial with concomitant coronary disease. 2
- Manage contributing factors including obesity, diabetes (given elevated cystatin C), and optimize glycemic control. 2, 6
Surveillance Plan
- Regular echocardiographic monitoring to detect progression to Grade II (pseudonormal pattern with E/A 0.8-2.0 and E/e' 8-14) or Grade III (restrictive pattern with E/A ≥2.0 and E/e' >14). 2
- Watch for left atrial dilatation, which is a marker of longstanding increased LA pressure in hypertensive heart disease. 1
- Consider diastolic stress testing if symptoms develop despite normal resting parameters. 2