Fig. 4

Echocardiography measures used to assess diastolic dysfunction and its progression. A Bidimensional apical 4-chamber view highlighting the visualized structures and the sample volume position to obtain a mitral inflow pulse wave Doppler echocardiography (PWD, yellow filled square) and a tissue Doppler image (orange filled square). B, C Normal (B) and abnormal (C) mitral inflow PWD showing the early (E) and late (A) wave peak velocity and the isovolumetric relaxation time (IVRT). D Bidimensional LAX view optimized to visualize the left atrial (LA) to obtain a mediolateral end-systolic diameter (D). E Tissue Doppler imaging at the septal corner of the mitral annulus to obtain early and passive filling myocardial velocities (e′ and a′, respectively). F Representative mitral PWD and tissue Doppler waves change as diastolic dysfunction progresses. LV, left ventricle; LA, left atrium, RV, right ventricle; RA; right atrium; MV, mitral valve; E, early wave peak velocity; (A) late wave peak velocity; IVRT, isovolumetric relaxation time; AoF, aortic flow; PA, pulmonary artery; D, diameter; E′, early filling velocity; A′, passive filling velocity; PWD, pulse wave Doppler; TDI, Tissue Doppler imaging