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Staging of diastolic dysfunction - 20-05-2007, 06:35 AM

We know the phases of diastolic function (isovolumic relaxation, early filling, diastasis, and late filling-atrial kick).
But someone asked me about the stages (grades) of DIASTOLIC DYSFUNCTION. I read my textbook, and found that diastolic dysfunction can be assesed by Doppler Echo, and can be divided into four stages (looking at the ratio of E/A- transmitral echo). Any idea? Plz share ur knowledge.
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Re: Staging of diastolic dysfunction - 22-07-2007, 03:01 AM

These refer to doppler patterns through the mitral annulus (i.e. ventricular inflow tract)

stage/grade 1: E:A ratio approaching 1
stage/grade 2: E:A ratio less than 1 (i.e. larger A wave than E wave)
stage/grade 3: Pseudonormalization of the E:A ratio (Both E wave and A wave enlarge, with E wave larger than A wave as is normally found, but both are elevated due to relaxation difficulty, and time course for the wave is shorter)
stage/grade 4: Disappearance of the A wave (the atria cannot contract against a very rigid ventricle so the A wave disappears)

got it frm answer.com.. hope it helps..
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Re: Staging of diastolic dysfunction - 22-07-2007, 05:09 PM

angel66 has already given and beside this according to American Heart Association diastolic function can also be quantitated by echocardiography:

1. Mild diastolic dysfunction or “impaired relaxation” (Grade 1)
  • Could also be subdivided with likely normal resting LV filling pressures (mild) and likely elevated left ventricular enddiastolic pressure (LVEDP) — mild to moderate; and
  • Usually no symptoms at rest with mild exercise limitation.
2. Moderate diastolic dysfunction or “pseudonormal” (Grade 2)
  • Associated with elevated LVEDP; and
  • Associated with exertional dyspnea and moderate functional impairment.
3. Severe diastolic dysfunction or “restrictive physiology” (Grade 3)
  • Associated with high LV filling pressures (LVEDP);
  • Dyspnea with minimal exertion and marked functional impairment; and
  • May be further classified as Grade 4, if the mitral Doppler inflow is not reversed with Valsalva’s maneuver.
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