# LV Diastolic Dysfunction Calculator

Helps diagnose abnormal diastolic function based on four clinical criteria, when LVEF is normal.

Refer to the text below the tool for more information about the predictive criteria for diastolic dysfunction.

The main causes of diastolic dysfunction are either structural heart diseases (hypertrophy, constriction, fibrosis) or functional heart disease (ischemia).

Left ventricle diastolic dysfunction may be diagnosed based on several echocardiographic findings, four of which are presented in this model.

The four criteria for diagnosing diastolic dysfunction:

1. Average E/e' > 14
2. Septal e' velocity < 7 cm/s or Lateral e' velocity < 10 cm/s
3. TR velocity >2.8 m/s
4. LA volume index > 34 mL/m2
 Points Diagnosis 0 – 1 Normal Diastolic Function 2 Indeterminate 3 – 4 Diastolic Dysfunction

1Average E/e' > 14
2Septal e' velocity < 7 cm/s or Lateral e' velocity < 10 cm/s
3TR velocity >2.8 m/s
4LA volume index > 34 mL/m2
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Steps on how to print your input & results:

2. Then you can click on the Print button to open a PDF in a separate window with the inputs and results. You can further save the PDF or print it.

Please note that once you have closed the PDF you need to click on the Calculate button before you try opening it again, otherwise the input and/or results may not appear in the pdf.

## Diagnosing LV Diastolic Dysfunction

In patients with preserved ejection fraction (EF) according to the current guidelines one should evaluate the following four criteria to assess diastolic dysfunction:

1. Average E/e' > 14
2. Septal e' velocity < 7 cm/s or Lateral e' velocity < 10 cm/s
3. TR velocity >2.8 m/s
4. LA volume index > 34 mL/m2

Each positive answer to the above counts as 1 point towards the final score, which is interpreted as follows:

 Points Diagnosis 0 – 1 Normal Diastolic Function 2 Indeterminate 3 – 4 Diastolic Dysfunction

LV diastolic dysfunction is present if more than 2 of the 4 criteria are met. The result is inconclusive if only half of the criteria are met.

Please note that an increased LAVI may be found in healthy well-trained athletes with bradycardia.

The main causes of diastolic dysfunction are either structural heart diseases (hypertrophy, constriction, fibrosis) or functional heart disease (ischemia). This may be associated with worse outcomes, including increased hospitalization and mortality.

Other parameters that may be used to assess diastolic function, including their cut-off points, are presented below:

 Parameter Cut-off value Mitral E/A ratio ≤ 0.8 & > 2 Peak E velocity > 50 cm/sec Deceleration time (DT) 140 - 240 msec Isovolumic relaxation time (IVRT) ≤ 70 - >100 mm/sec Peak tricuspid regurgitation (TR) velocity > 2.8m/sec

Diastolic dysfunction in patients with reduced ejection fraction or structural heart disease may be classified through 4 grades:

 Grade Description Grade I – impaired relaxation Decreased suction of the left ventricle. Grade II – pseudonormalization Increased stiffness of the left ventricle, elevated left atrial pressure. Grade III – reversible restrictive filling High LAP, noncompliant LV. May be reversible with reduction of preload, for example through diuretics. Grade IV – irreversible restrictive filling High LAP, noncompliant LV. Does not benefit from reduction of preload.

## References

Nagueh SF, Smiseth OA, Appleton CP, et al. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2016; 29(4):277-314.

Toida T, Toida R, Yamashita R, et al. Grading of Left Ventricular Diastolic Dysfunction with Preserved Systolic Function by the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging Recommendations Contributes to Predicting Cardiovascular Events in Hemodialysis Patients. Cardiorenal Med. 2019; 9(3):190-200.

Specialty: Cardiology

System: Cardiovascular

Objective: Diagnosis

Article By: Denise Nedea

Published On: July 15, 2020 · 12:00 AM

Last Checked: July 15, 2020

Next Review: July 15, 2025