Diastolic assessment in atrial fibrillation
Explore the atrial-fibrillation filling-pressure pathway, its primary and secondary measurements, and rhythm-specific source context.
Method
2025 ASE Figure 8 · 4 primary markers; if exactly 2, apply 3 secondary markers
Use the measurement units shown below. Some fields apply only to a selected method or condition; follow the interactive tool’s method choices. The interactive tool keeps missing measurements incomplete and provides its method-specific results and reference context.
Measurements and acquisition
Mitral E velocity cm/s
PW Doppler at the mitral leaflet tips
- Place the PW sample between the mitral leaflet tips.
- Record at end-expiration with a clear E and A wave.
- Measure the requested peaks or trace the requested envelope.
Septal E/e′
PW tissue Doppler at the mitral annulus
- Place the sample at the septal or lateral mitral annulus.
- Use tissue-Doppler settings and align with annular motion.
- Measure the early diastolic e′ peak and average representative beats.
TR peak velocity m/s
CW Doppler through the TR jet
- Search RV inflow, apical four-chamber, and subcostal windows; use the highest well-aligned signal.
- Trace the dense primary edge (‘chin’), not faint overgained noise, and reject truncated triangular envelopes when estimating pressure.
- Average three representative beats; in atrial fibrillation average 5–10 beats and exclude post-pause or post-ectopic velocities.
PASP mmHg
Contemporaneous cuff or invasive value
- Use a pressure obtained in the same hemodynamic state as the echo.
- Confirm the value is entered in mmHg.
- Do not mix values acquired under different loading conditions.
Mitral E deceleration time ms
Spectral Doppler timing
- Use a sweep speed that clearly shows the interval boundaries.
- Measure from the specified onset to offset.
- Average representative beats using consistent rhythm handling.
LA reservoir strain %
Enter the measured value in the displayed unit · Optional
- Confirm the variable matches the selected formula.
- Use the unit displayed beside the field.
- Keep measurements from the same representative hemodynamic state.
Pulmonary vein S/D
Pulsed-wave Doppler · Optional
- Place the sample volume at the specified annulus or outflow tract.
- Align the Doppler beam with flow and record a clean envelope.
- Trace the modal velocity envelope and use the reported VTI.
Body mass index kg/m²
Record the units, date and measurement source · Optional
- Use measured height and weight where feasible. Record the units, date and whether a value was reported or estimated.
- Fluid status and weight changes affect BSA. Document any substituted weight; do not silently replace measured weight with ideal or dry weight.
- Use the unit named by the field. BSA is in m²; height and weight can be converted in the Body surface area calculator. Keep the formula with serial indexed results.
Sources and method context
American Society of Echocardiography · 2025 · Evaluation of Left Ventricular Diastolic Function and HFpEF Diagnosis · Table 7 p. 20 · Figure 8 p. 27
- AF decision pathway · Figure 8 · PDF p. 27
Four primary markers and the LARS, pulmonary-vein S/D, and BMI secondary branch.
- AF measurement context · Table 7 · PDF p. 20
AF-specific filling-pressure variables and rhythm-aware interpretation.
Catalogue review status: Exact guideline locator mapped · clinical sign-off pending
These pages describe the educational tool. Interpret measurements with the complete clinical context and the method’s acquisition limitations.