FIGURE 17.12. Schematic of different Doppler patterns seen in healthy subjects and patients with varying stages of diastolic dysfunction. Top: The mitral inflow pattern recorded from the apex of the left ventricle. Middle: Pulmonary vein flow. Bottom: Doppler tissue imaging recorded from the mitral valve anulus. In general, the appearance of grade 4 dysfunction is similar to that of grade 3. Clinically, grade 4 is considered irreversible, whereas the grade 3 pattern will revert to grade 2 with maneuvers that reduce LV filling acutely or after successful therapy. See text for further details. A, A-wave reversal; D, diastole; S, systole.
FIGURE 17.13. Example of a patient with a pseudonormal mitral inflow pattern (grade 2 diastolic dysfunction). Note the E/A ratio of approximately 1.8 but the reduced systolic velocity in the pulmonary veins. D, diastole, S, systole.
