Evaluation of diastolic function by tissue Doppler

Conventionally, Doppler evaluation of diastolic function is by assessing the mitral flow velocities in diastole. But this has inherent limitation as being highly dependent on ventricular preload. Tissue Doppler techniques for assessment of ventricular diastolic function is less load dependent than mitral inflow velocities. Ea is the early myocardial relaxation velocity as the mitral annulus ascend during the initial rapid filling phase of ventricular diastole. Highest Ea measured from any aspect of the mitral annulus from apical views is termed the peak Ea velocity. It is more likely at the lateral annulus, with septal Ea velocity being slightly lower. Ea velocity measured from the lateral annulus less than eight centimeters per second in older adults would indicate impaired left ventricular relaxation (diastolic dysfunction). Since Ea is relatively resistant to changes in left ventricular filling pressure, this can be used to differentiate normal from a pseudo normal mitral inflow pattern. Reversal of Em / Am (less than one) and an absolute value of Em less than eight centimeters per second are also indicative of diastolic dysfunction.