Diastolic Dysfunction Classifier for Normal LVEF and detemination Filling Pressures for Myocardial Disease or Low LVEF

ASE 2016 – Diastolic Function (Normal EF) Classifier

Fill in what you have. Missing items are not counted in the denominator. Thresholds reflect ASE 2016.

Average E/e' ratio

Abnormal if > 14

TR peak velocity (m/s)

Abnormal if > 2.8 m/s

LA volume index (mL/m²)

Abnormal if > 34 mL/m²

Mitral annular e' velocity (cm/s)

Abnormal if < 7

Abnormal if < 10

This counts as one variable. If either septal or lateral meets the abnormal cutoff, this variable is positive.

How it works (ASE 2016 logic)

Applies only to patients with normal LVEF. Four variables are evaluated and only the ones you filled in are counted:

• Average E/e' ratio > 14
• Mitral annular e' velocity reduced: septal e' < 7 cm/s or lateral e' < 10 cm/s (counts as one variable)
• TR peak velocity > 2.8 m/s
• LA volume index > 34 mL/m²

Decision rule (use only the available variables):

• > 50% of available variables are positive → Diastolic dysfunction present
• = 50% positive → Indeterminate
• < 50% positive → Normal diastolic function

ASE 2016 – Diastolic Function Grading (Reduced EF / Myocardial Disease)

Start with mitral inflow (E and A). Use supportive criteria only when needed. Missing items are not counted; PV S/D can substitute when one main item is unavailable.

Mitral E velocity (cm/s)

Used with E/A and the 50 cm/s threshold

Mitral A velocity (cm/s)

E/A is computed from E ÷ A

Average E/e' ratio

Abnormal if > 14

TR peak velocity (m/s)

Abnormal if > 2.8 m/s

LA volume index (mL/m²)

Abnormal if > 34 mL/m²

Pulmonary vein S/D ratio (optional)

Abnormal if < 1; used only when one main item is missing

How it works (ASE 2016 logic)

For reduced EF or myocardial disease & sinus rhythm:

• E/A ≤ 0.8 and E ≤ 50 cm/s → Grade I
• E/A ≥ 2 → Grade III
• Else (E/A ≤ 0.8 with E > 50, or 0.8 < E/A < 2): evaluate 3 supportive criteria: Avg E/e' > 14, TR Vmax > 2.8 m/s, LAVI > 34 mL/m².

Supportive decision (use only available items; PV S/D < 1 may substitute when one main item is unavailable):

• 2 or 3 positive → Grade II (pseudonormal)
• 0 or 1 positive → Grade I
• If only one supportive item available → Indeterminate