Table 5 Table of the supplementary measures of LV diastolic function

Transmitral A wave duration

Measured by PW Doppler, the time from the onset of the A-wave to the end of flow at valve closure. A sample volume placed at the level of the mitral annulus provides clearer identification of A onset and cessation than a sample volume placed at the leaflet tips. The measurement is more easily made when the A-wave is clearly seen to start and end at the zero-velocity baseline. Identifying the onset of flow may be difficult when E and A are fused

Pulmonary vein flow

In the apical 4-chamber view, superior angulation of the transducer and use of colour flow will help locate the PV. The RUPV is usually easiest to identify and is adjacent to the atrial septum. If the signal is weak, manoeuvre the patient into a more supine position. Place the PW Doppler sample volume (1–3 mm volume) 1–2 cm into the RUPV

Wall filter settings should be lowered (100–200 MHz). Sweep speed should be increased to > 100 mm/s. Ensure clear visualisation of the atrial reversal velocity waveform. Measurements should be averaged over 3 cardiac cycles, at end expiration. When two PV S peaks are present (S1 and S2), peak S2 should be measured for the S/D ratio

PV Ar duration—measure by PW Doppler from the onset of the Ar wave to the end of flow. Optimised alignment with flow is usually best when sampling within the right PV adjacent to the inter-atrial septum. Low velocity reject/wall-filter should be adjusted to ensure that the onset/cessation of flow is clearly identified

For the purpose of calculating the Ar-A, measurements of A and Ar duration should be made during cardiac cycles with similar R-R intervals. When the onset of either A or Ar flow is indistinct or there is E & A fusion, the preceding P-wave or QRS can be used as the starting reference point. Irrespective of the degree of impaired diastolic function, the onset of both A and Ar flow is simultaneous; it is the time-point at which each signal ends that identifies the difference in duration. Therefore, measuring from a common starting point to the end of each signal enables an estimation in the difference in duration between them. However, it is essential that R-R intervals are identical for both measures when applying this method

L-wave

The velocity of transmitral flow during the period of diastasis