Diastolic dysfunction and sex-specific progression to HFpEF: current gaps in knowledge and future directions

Table 1 Recommended echocardiography parameters to classify diastolic function in individuals with normal LV ejection fraction according to Nagueh et al. 2016 and 2009 guidelines and known sex differences in these parameters

Parameter	Cut-off 2016 [3]	Cut-off 2009 [15]^*	Sex -differences
Average E/e′ ratio	> 14	-	± 1 point higher in women [11]
Septal or lateral e′ velocity	< 7 cm/s or < 10 cm/s	< 8 cm/s or < 10 cm/s	no significant differences
TR velocity	> 280 cm/s	-	no significant differences
LAVI	> 34 mL/m²	> 34 mL/m²	± 2 mL/m² point higher in men [26]
< 50% positive: normal diastolic function 50% positive: indeterminate diastolic function > 50% positive: diastolic dysfunction

Abbreviations: E/e′ ratio, the ratio of early mitral valve inflow (E) velocity divided by average e′; e′, mitral valve annular early filling tissue Doppler velocity; TR, tricuspid regurgitation; LAVI, left atrial volume index
^*After initial assessment of diastolic function using the parameters in the table, it was recommended to take into account E/A ratio (also during Valsalva manoeuver), E wave deceleration time, average E/e′ ratio, and the time difference between reversed pulmonary venous flow (Ar) and A wave duration for detailed LVDD assessment

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