E Wave Deceleration Time Assessment in Elderly Males
An E wave deceleration time (DT) of 236 msec is within the normal range for an elderly male, even with impaired renal function, as the normal DT range for individuals over 60 years is 142-258 msec. 1
Age-Specific Normal Values
The assessment of diastolic function parameters must account for age-related physiologic changes:
- For patients over 60 years of age, the normal DT range is 142-258 msec 1
- A DT of 236 msec falls comfortably within this reference range and does not suggest abnormal diastolic function based on this parameter alone 1
- Normal aging is associated with slowing of LV relaxation, which leads to changes in filling patterns that resemble mild diastolic dysfunction in younger patients 1
Context of Impaired Renal Function
While the patient has impaired renal function, this does not alter the interpretation of the DT value itself:
- Impaired renal function is associated with increased vascular stiffness and cardiovascular risk, but the DT measurement remains interpretable using standard age-adjusted reference ranges 2, 3
- The presence of renal dysfunction should prompt comprehensive diastolic function assessment using multiple parameters rather than relying on DT alone 1
Comprehensive Diastolic Assessment Required
DT should not be interpreted in isolation when evaluating diastolic function 1:
- The 2016 ASE/EACVI guidelines recommend using four key variables: septal e' <7 cm/sec, lateral e' <10 cm/sec, average E/e' >14, LA volume index >34 mL/m², and peak TR velocity >2.8 m/sec 1
- Diastolic dysfunction is diagnosed when more than half of available parameters meet abnormal cutoff values 1
- DT becomes particularly important when E/A ratio is ≥2 or in patients with recent cardioversion where A-wave velocity may be reduced due to atrial stunning 1
Clinical Pitfalls to Avoid
- Do not diagnose diastolic dysfunction based solely on DT, especially in elderly patients where overlap exists between normal aging and pathologic changes 1
- A DT <160 msec typically indicates grade III diastolic dysfunction when accompanied by E/A ≥2, but this patient's DT of 236 msec does not meet this criterion 1
- Some patients with E/A ≤0.75, DT >140 msec, but E/e' ≥10 represent a distinct group with prognosis similar to pseudonormal filling patterns, requiring careful evaluation of additional parameters 4, 5