Left Ventricular Diastolic Function: Evaluation Algorithm Based on ASE/EACVI 2016 Criteria
Key Evaluation Variables
According to the ASE/EACVI (2016) guidelines, four criteria are used to assess left atrial pressure (LAP) and left ventricular diastolic function:
| Parameter | Threshold Value (elevated LAP) |
|---|---|
| Average E/e' | >14 |
| e' Velocity (tissue Doppler) | Septal <7 cm/s or lateral <10 cm/s |
| TR Velocity | >2.8 m/s |
| LA Volume/Index (LAVI) | >34 ml/m² |
Interpretation Algorithm
If all three variables (e' velocity, E/e' ratio, and PASP) do not reach the threshold values for elevated LAP (Figure 3), then the LA pressure is normal and diastolic function is considered normal.
Grade 1 diastolic dysfunction is present with reduced e' velocity combined with a normal E/e' ratio, normal PASP, and E/A ratio ≤0.8.
When e' velocity is reduced and the E/A ratio is >0.8, additional variables need to be assessed, as some of these patients may have elevated LAP.
Similarly, if only PASP or only the E/e' ratio, or any two of the three variables (e' velocity, E/e', PASP) correspond to elevated LAP, additional parameters should be considered for a final conclusion.
Additional Criterion for Grade 1
In an applied study, grade 1 diastolic dysfunction (according to the 2016 ASE/EACVI criteria) with normal LVEF was also determined by the combination of E/A <0.8 + E <50 cm/s. The examination was performed using 2D echocardiography with an assessment of the septal-lateral tissue Doppler ratio é/a.
Frequently asked questions
What threshold value of E/e' indicates elevated LA pressure?
An average E/e' >14 corresponds to elevated left atrial pressure according to the ASE/EACVI 2016 criteria.
What values of e' velocity are considered reduced?
Septal e' velocity <7 cm/s or lateral e' <10 cm/s.
How to interpret the situation when e' is reduced and E/A >0.8?
In this case, additional variables need to be assessed, as some of these patients may have elevated LAP.
When is diastolic function considered normal?
If all three variables (e', E/e', PASP) do not reach the threshold values for elevated LAP, the LA pressure is normal, and diastolic function is normal.
What criteria define grade 1 dysfunction?
Reduced e' velocity with normal E/e', normal PASP, and E/A ≤0.8; additionally, the combination of E/A <0.8 + E <50 cm/s was applied.