by Cory Maxwell, MD
As with all portions of a complete TEE examination the ECG is imperative to compare the timing of pressure changes, motion, and flow with the cardiac cycle. This is particularly true in the assessment of diastolic function/dysfunction, and all tracings should be evaluated for appropriate ECG tracing prior saving images.
The following patient populations SHOULD NOT have Transmitral flow or Tissue doppler for the purpose of diastolic function assessment:
- Mitral Stenosis*
- S/P Mitral annuloplasty*
- S/P Mitral valve replacement*
- LVAD
- V-paced
*These patients should still have transmitral flow measured to assess the gradient across the valve
The following patient populations SHOULD have Transmitral flow or Tissue doppler for the purpose of diastolic function assessment, despite noted limitations:
- Tachycardia**
- A-Paced**
- AV-Paced**
- Atrial Fibrillation+
- Atrial Flutter+
**Transmitral flow, Tissue Doppler, and Pulmonary Vein flow may be affected by hear rate, PR interval, or AV delay which may make interpretation difficult or impossible.
+The Transmitral flow will lack an A wave and the Tissue Doppler will lack an A’ wave, however the E/E’ ratio will reflect the filling pressures. The Pulmonary and Hepatic vein flow will be difficult to interpret due to the abnormal rhythm.