Canonical: https://echosuite.app/guides/diastolic-af/ # Diastolic assessment in atrial fibrillation Explore the atrial-fibrillation filling-pressure pathway, its primary and secondary measurements, and rhythm-specific source context. Created by [Mohammed Kamareddine, MD](https://echosuite.app/about/) · [Sources & educational scope](https://echosuite.app/about/) [Open interactive calculator →](https://echosuite.app/calculators/#diastolic-af) ## 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 [Primary reference](https://www.asecho.org/wp-content/uploads/2025/07/Left-Ventricular-Diastolic-Function.pdf) - 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. ## Keep exploring - [Apical four chamber acquisition guide](https://echosuite.app/guides/views/apical-four-chamber/) · [Open in Probe Lab](https://echosuite.app/#a4c) - [Left atrial pressure calculator: E/e′ method](https://echosuite.app/guides/lap-ee/) - [Left atrial pressure calculator: mitral regurgitation velocity](https://echosuite.app/guides/lap-mr/) - [Left atrial volume index calculator: LAVI](https://echosuite.app/guides/la-size/) - [Left ventricular pressure calculator](https://echosuite.app/guides/lv-pressure/) [All echo guides](https://echosuite.app/guides/) · [Learning paths](https://echosuite.app/learn/)