Diastolic Function Assessment in 2025: Detailed Guidelines
🧠Stepwise Approach to Diastolic Function Assessment (2025 ASE Update)
🔹 Step 1: Assess LV Relaxation
This step evaluates early diastolic myocardial velocity (e′) using tissue Doppler imaging:
- Septal e′ ≤ 6 cm/s
- Lateral e′ ≤ 7 cm/s
- Average e′ ≤ 6.5 cm/s
These values suggest impaired myocardial relaxation. Age-specific cutoffs may be considered, especially in older adults or athletes.
🔹 Step 2: Evaluate Markers of Elevated Left Atrial Pressure (LAP)
If e′ is reduced, assess the following markers to determine LAP:
- E/e′ ratio: Average E/e′ > 14; Septal E/e′ > 15 or lateral E/e′ > 13
- Left Atrial Volume Index (LAVI): LAVI > 34 ml/m²
- E/A ratio: E/A ≤ 0.8 (impaired relaxation), E/A ≥ 2 (restrictive filling)
- Left Atrial Reservoir Strain (LARS): LARS ≤ 18%
- Pulmonary vein S/D ratio: S/D ≤ 0.67
- Isovolumic Relaxation Time (IVRT): IVRT ≤ 70 ms
- Tricuspid regurgitation (TR) velocity: TR velocity ≥ 2.8 m/s or PASP ≥ 35 mmHg
🔹 Diagnostic Criteria
- Diastolic dysfunction is present if:
- e′ is reduced and ≥1 marker from Step 2 is abnormal
- e′ is preserved but ≥2 markers from Step 2 are abnormal
🔹 Grading Diastolic Dysfunction
- Grade 1 (Impaired relaxation): E/A ≤ 0.8, normal LAP markers
- Grade 2 (Pseudonormal): E/A between 0.8–2 with elevated LAP markers
- Grade 3 (Restrictive filling): E/A ≥ 2 with markedly elevated LAP
🔹 Special Populations
Separate algorithms are provided for:
- Atrial fibrillation
- Pulmonary hypertension
- Heart transplant recipients
- Valvular heart disease
- Pericardial constriction
- Hypertrophic cardiomyopathy
📄 Sources & Guidelines