Estimation of left atrial pressure and severity of diastolic dysfunction in patients with left ventricular ejection fraction <50% OR a left ventricular ejection fraction ≥50% and diastolic dysfunction*

LAP: left atrial pressure; E: peak velocity of early left ventricular filling; A: peak velocity of late left ventricular filling; e': peak early diastolic velocity of left ventricular myocardium adjacent to the mitral annulus by tissue Doppler; TR: tricuspid regurgitation; LA: left atrial; LV: left ventricular; LVEF: left ventricular ejection fraction; S: forward systolic flow; D: forward diastolic flow.

* The above algorithm should not be applied to patients with normal LV systolic and diastolic function (ie, those with LVEF ≥50% and no diastolic dysfunction or with indeterminate diastolic function), significant mitral valve disease (moderate or severe mitral annular calcification, any mitral stenosis, greater than moderate mitral regurgitation, mitral valve repair, or a prosthetic mitral valve), LV mechanical circulatory support, left bundle branch block, ventricular paced rhythm, or constrictive pericarditis.

¶ For patients with LVEF ≤50%, if one of the three numbered parameters cannot be measured, a pulmonary vein S/D ratio <1 can be substituted as a criterion suggestive of elevated LAP.

Δ This criterion should not be used in patients with significant pulmonary disease.

◊ The LA volume index criterion should not be used in athletes or in patients with atrial fibrillation or more than mild mitral stenosis or regurgitation.