Box 1. Recommended echocardiographic indices for diagnosing HFpEF and diastolic dysfunction
European Society of Cardiology clinical practice guidelines on acute and chronic heart failure 20163
Relevant structural heart disease

  • Left ventricular hypertrophy (left ventricular mass index >115 g/m2 for males and >95 g/m2 for females)

  • Left atrial enlargement (left atrial volume index >34 mL/m2)

Diastolic dysfunction

  • Early diastolic tissue velocity (e’ mean septal-lateral <9 cm/sec)

  • Ratio between early mitral inflow velocity and mitral annular early diastolic velocity (E/e’>13)

  • Deceleration time (DecT) of mitral valve early diastolic inflow (MV-E) m/sec

  • E/A ratio <1 or >2

  • Isovolumetric relaxation time (IVRT)

American Society of Echocardiography and the European Association of Cardiovascular Imaging 2016 9
Annular e’ velocity

  • Septal e’ <7 cm/sec

  • Lateral e’ <10 cm/sec

Average E/e’ ratio >14
Left atrium maximum volume index (>34 mL/m2)
Peak tricuspid regurgitation velocity >2.8 m/sec

Note: LV diastolic function is normal if more than half of the variables do not meet the cut-off for identifying abnormal function.

cm/sec = centimetres per second. E = early mitral diastolic inflow. e’ = early diastolic tissue velocity. E/A = ratio between peak early (E) and late (A) diastolic filling velocities. E/e’ = ratio between early mitral inflow velocity and mitral annular early diastolic velocity. g/m2 = grams per metre squared. LV = left ventricle. m/sec = metres per second. mL/m2 = millilitres per metre squared. MV = mitral valve.