Diagnosis and treatment of heart failure with preserved left ventricular ejection fraction

Table 3 Echocardiographic indices of diastolic dysfunction

1. The ratio of the mitral blood flow velocity into the LV in early diastole (the E wave) to peak blood flow velocity in late diastole caused by atrial contraction (the A wave), or the E/A ratio, ≥ 2. The normal E/A is approximately 0.8. However, tachycardia, atrioventricular block, and left bundle branch block can lead to fusion of E and A waves, and ambiguity in diastolic function assessment.

2. Increased left atrial pressure measured by early mitral blood flow velocity across the mitral valve (E wave) to the early diastolic velocity (e’) of the lateral mitral annulus, or E/e’ ratio. An E/e’ ratio 10 = mild and E/e’ ratio > 14 = significant LV dysfunction. If the lateral mitral annulus e' velocity is not quantifiable, the septal mitral annular e' velocity can be used. In this case, the E/e’ is increased if the ratio is > 15.

3. Lateral mitral annular e’ velocity < 10 cm/s or septal e’ mitral annular velocity < 7 cm/s.

4. Pulmonary artery systolic pressure > 35 mmHg indicative of pulmonary arterial hypertension. Pulmonary artery systolic pressure = 4 × (peak tricuspid regurgitation velocity)2 + estimated right atrial pressure. These criteria should not be used in patients with significant pulmonary disease.

5. An echocardiographic determination of global longitudinal strain of -16.05 ± 2.16. This measurement can separate patients with HFpEF from patients with hypertension and normal controls in whom the global longitudinal strain measurements are -18.58 ± 2.84 and -19.59 ± 1.49, respectively.

HFpEF: Heart failure with preserved ejection fraction.