Feasibility of Echocardiographic Diastolic Parameters and
Algorithms
Most of the 2016 parameters had feasibility above 95 %, except TR Vmax
(65 %), pulmonary parameters (64-70 %), mitral valve A velocity and
E/A ratio (93 %) (Table 2). Poor feasibility of TR Vmax was due to
indistinct visualization of an envelope for proper labelling, the mitral
valve A velocity, and as consequence E/A ratio, was mostly (73 %) due
to atrial fibrillation. The remaining parameters used in the 2009
guidelines had moderate feasibility below 80 %, except the mitral valve
DT (99 %) (Table 2).
The 2009 algorithm is challenged with many indeterminate cases by its
assumption of a combined enlarged LA and reduced e’, in order to
distinguish DD from normal diastolic function (Figure 2). In our
population all cases were assumed as having abnormal diastolic function,
since patients were planning to undergo cardiac surgery. According to
the 2009 algorithm DD was graded by allowing the majority of the five
suggested parameters (E/A ratio, decrease in E/A ratio during Valsalva,
time difference between the pulmonal reversal A-wave and mitral A-wave,
average E/e’ and mitral valve DT) decide the gradings. 85 cases (24 %)
had indeterminate gradings.
According to the 2016 algorithm, 39 cases (11 %) had indeterminate
grading of DD; 27 with unavailable E/A ratio, 8 with two available
criteria and unavailable S/D ratio and 4 with only one available
criterion.