For the past 2 weeks, we have discussed two algorithms used for determining the presence & grade of diastolic function. If you missed out or want to review them, you can find them here:
This week, we are going to discuss assessing diastolic function in patients with arrhythmia’s.
When patients fall into the following categories, the assessment of diastolic function changes, we are unable to use the algorithms provided in previous blog series:
The guidelines break down each disease individually. Remember, the more of the following parameters you can combine, the stronger the case for left ventricular elevated filling pressures.
There are elevated filling pressures if any of the following are true:
Other supportive findings that suggest elevated filling pressures with atrial fibrillation patients include:
There are elevated filling pressures if any of the following are true:
If mitral E and A-wave are fused together, you may use a compensatory beat following a PVC to measure the E and A-wave velocities and assess diastolic function.
If average E/e’ is unobtainable or not used routinely in your lab, use “septal E/e’ >15” or “lateral E/e’ >13” to determine elevated filling pressures.
Pulmonary venous systolic filing fraction can be calculated as follows:
VTI of S-wave / (VTI of S-wave + VTI of D-Wave)
As long as there is no fusion of the mitral E and A-waves, the variables used to grade diastolic function likely remain valid. You can make your way back up to the flow charts.
