LV Diastolic Dysfunction Grading (ASE/EACVI 2016)
2016 ASE/EACVI algorithm for grading left ventricular diastolic dysfunction using 4 variables: mitral annular e', E/e' ratio, left atrial volume index, and peak TR velocity.
Score interpretation
→ All 4 criteria negative: No diastolic dysfunction. Normal LV filling pressures. If EF is preserved and symptoms present — consider non-cardiac cause of dyspnoea (anaemia, COPD, deconditioning).
→ 1/4 criteria positive: Indeterminate diastolic function or Grade 1 diastolic dysfunction (mild). Impaired relaxation with normal filling pressures. Treat hypertension, obesity, diabetes; repeat echo in 12 months; consider stress echocardiography if HFpEF suspected.
→ 2/4 criteria positive: Indeterminate — cannot reliably grade. Use additional parameters (Valsalva manoeuvre, pulmonary vein flow, diastolic stress test). Clinical context essential. Refer to advanced HF echo assessment.
→ 3–4/4 criteria positive: Grade 2 (pseudonormal) or Grade 3 (restrictive) diastolic dysfunction. Elevated LV filling pressures. High likelihood of HFpEF. Diuretic therapy; treat underlying HTN/AF; HF clinic; consider SGL T2i; BNP/NT-proBNP; cardiology referral.
Interpretation bands for the Diastolic Dysfunction Grade. Apply clinical judgement and local guidance.
References
Related
Curated clinical cross-links plus same-class fallbacks.
- Dobutamine (Acute HF / Stress Echo) · Inotrope / Acute Heart Failure
- Empagliflozin (Elderly HFpEF/HFrEF) · SGLT2 Inhibitor
- Sildenafil · PDE5 Inhibitor — Pulmonary Arterial Hypertension
- Sildenafil (CTD-Associated PAH / Raynaud's) · Phosphodiesterase-5 (PDE5) Inhibitor
- Desmopressin (Surgical — Haemostasis/Platelet Dysfunction) · Vasopressin Analogue V2 (Antidiuretic/Haemostatic)
- Vardenafil · PDE5 Inhibitor — Erectile Dysfunction
- Acute Heart Failure · ESC 2021 Heart Failure Guidelines; NICE NG106
- NSTEMI / Unstable Angina · ESC 2020 NSTEMI Guidelines; NICE NG185
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.