Diastolic Function in Mitral Valve Disease
A 77-year-old male patient with a medical history significant for mitral regurgitation (MR), hypertension, diffuse coronary artery disease, and chronic kidney disease stage III was referred for management of chronic systolic and diastolic heart failure. He reported New York Heart Association Class II dyspnea on exertion. The patient's blood pressure was 149/71 mmHg with a heart rate of 60 bpm at rest. An electrocardiogram showed normal sinus rhythm. Transthoracic echocardiography demonstrated severe MR with small flail segment at A2, effective orifice area of 0.4 cm2, regurgitation volume of 62 ml, systolic flow reversal of pulmonary vein, and severely dilated left atrium (LA) (Figure 1). Mitral valve inflow assessment revealed peak E velocity of 131 cm/s, E/A of 1.14, E/e' of 15.7, tricuspid regurgitation velocity of 2.1 m/s, and LA volume index of 52ml/m2 (Figure 2).
How would you grade this patient's degree of diastolic dysfunction?