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Let’s consider this patient, admitted with a previous diagnosis of severe MR secondary to mitral valve prolapse.
At the transthoracic 2D and 3D examinations the mitral valve shows a systolic prolapse of P3. The short-axis color Doppler of the valve shows a regurgitant jet originating near the posterior commissure (not particularly evident).
He is a 65-year-old chinese male presenting with SOB since the last 3 months. He is a smoker, has non-insulin-dependent diabetes and hyperlipidemia, and normal coronary arteries. Heart rate= 80 bpm. The echocardiogram shows: normal LV end-diastolic volume= 61 ml/m2 and EF (74%), no MAD, severe LA dilatation (biplane, 71 ml/m2), mitral peak E wave= 114 cm/2, E/e’= 14, increased estimated LV filling pressures (see our online Calculator for the estimation of LV filling pressures) (Figure 8), normal pulmonary systolic pressure= 33 mmHg, and normal right ventricular dimensions and systolic function.
In this specific situation, the 2016 ASE-EACVI Diastolic Function Recommendations probably overestimate filling pressures and diastolic dysfunction class because of the increased E wave secondary to increased transmitral stroke volume (this is one of the several limitations of the current Recommendations).
![The online calculator for the estimation of left ventricular filling pressures and diastolic function](https://echobyweb.com/wp-content/uploads/2022/03/LV-FP-Calculator.jpg)
Results of the online Calculator for the estimation of LV Filling Pressures and Diastolic Function in our patient (Figure 8, right panel).
The ASE-EACVI algorithm suggests Increased LV filling pressures (> 12 mmHg) and Class II Diastolic Dysfunction. The recently published PDP algorithm equally suggests increased filling pressures (a result of increased estimated Pulmonary Diastolic Pressure + increased tricuspid regurgitation velocity + dilated LA).