Issues in diagnosing grade 1 diastolic dysfunction: Pearls and Perils
Doppler E/A ratio reversal is probably the most reported abnormality in clinical echocardiography. We are also pleased to label it as a grade 1 diastolic dysfunction. Making a significant population who come for regular health checks anxious and worried.
Sharing a presentation from the Annual conference ECHO INDIA 2019, I participated in a symposium on Diastolic dysfunction.
Topic : Issues in diagnosing grade 1 diastolic dysfunction: Pearls and Perils
How did we get into this academic trap? Should we continue this practice?
The current ASE guidelines 2016 have a clear message. It has taken off the E/A ratio from the Initial screening for diastolic dysfunction.
Summary & Final message
Are we ready for the change? By understanding a simple concept, one can reduce the incidence of indiscriminate diagnosis of grade 1 diastolic dysfunction.
- E/A ratio apparently has a no role in diagnosing diastolic dysfunction in the normal population who have normal EF %.
- Hence, never report E/A ratio in Isolation as grade 1 diastolic dysfunction.
- However, in patients with HFrEF it does help in triaging diastolic dysfunction.
- Always look for symptoms and 2D features (Unexplained dyspnea, LA enlargement, LVH ) before considering diastolic dysfunction.
*For advanced readers and researchers grade 1 diastolic dysfunction does have a deep meaning and always continues to puzzle.
For all those anxious patients who ramble around with a report of grade 1 diastolic dysfunction, I can assure you this. Please realize, 9/10 times, this is just a decorative echocardiography abnormality meant to add some spice to the report does not have any significance.
*Will post a PPT presentation shortly.