LV Diastolic Dysfunction via Mitral Inflow Doppler

Understanding LV Diastolic Dysfunction via Mitral Inflow Doppler:

Mitral inflow Doppler patterns reflect LV diastolic function. Pulsed-wave Doppler at the mitral valve leaflets shows E (early filling) and A (atrial contraction) waves.

Here’s how the patterns change:

1️⃣ Normal Filling:

- E/A >1

- Deceleration Time (DT) <220 ms

- Normal relaxation and compliance.

2️⃣ Grade I – Mild Dysfunction (Impaired Relaxation):

- E/A <1

- DT >220 ms

- Relaxation is delayed, atrial kick becomes dominant.

3️⃣ Grade II – Moderate Dysfunction (Pseudonormal):

- E/A >1 (appears normal!)

- DT 150–200 ms

- LA pressure increases to "normalize" filling—requires Tissue Doppler to unmask.

4️⃣Grade III – Severe Dysfunction (Restrictive Pattern):

- E/A >1.5

- DT <150 ms

- Very high LA pressures, stiff LV—hallmark of poor prognosis.

⚠️Always correlate with tissue Doppler (E/e’), LA size, pulmonary vein flow, and clinical picture. A pseudonormal pattern can be misleading without these.

Ref:

Ho CY, Bulwer BE. In: Solomon SD, Bulwer BE. Essential Echocardiography. Humana Press, 2007:124.

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