TDE assessment of mitral annulus velocity and diastolic dyfunction

Tissue Doppler echocardiography (TDE) can be used to assess the motion of the mitral annulus during diastole as a method of detecting diastolic dysfunction. The mitral valve ring moves toward the left ventricular apex (upward on the image) during systole. During diastole, there are two phases of motion. An early phase of movement away from the cardiac apex (downward on the image) corresponds to early diastolic filling and is analogous to the E wave on the Doppler profile of mitral inflow; it is marked E'. A late phase of movement in the same direction corresponds to atrial contraction and is analogous to the A wave; it is marked A'. The E' wave is blunted in the presence of either impaired relaxation or diminished compliance (restrictive physiology).