Canonical: https://echosuite.app/guides/diastolic-mr/

# Diastolic assessment in significant mitral regurgitation

Find the filling-pressure pathway for significant mitral regurgitation, with the measurements and qualifications specific to that method.

Created by [Mohammed Kamareddine, MD](https://echosuite.app/about/) · [Sources & educational scope](https://echosuite.app/about/)

[Open interactive calculator →](https://echosuite.app/calculators/#diastolic-mr)

## Method

2025 ASE Table 7 · MR-specific filling-pressure indicators

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

### LVEF

Enter the measured value in the displayed unit

- Depressed
- Preserved
- Confirm the variable matches the selected formula.
- Use the unit displayed beside the field.
- Keep measurements from the same representative hemodynamic state.

### IVRT  ms

Spectral Doppler timing · Optional

- Use a sweep speed that clearly shows the interval boundaries.
- Measure from the specified onset to offset.
- Average representative beats using consistent rhythm handling.

### Pulmonary vein Ar duration  ms

Spectral Doppler timing · Optional

- Use a sweep speed that clearly shows the interval boundaries.
- Measure from the specified onset to offset.
- Average representative beats using consistent rhythm handling.

### Mitral A duration  ms

Spectral Doppler timing · Optional

- Use a sweep speed that clearly shows the interval boundaries.
- Measure from the specified onset to offset.
- Average representative beats using consistent rhythm handling.

### R peak → E onset  ms

Spectral Doppler timing · Optional

- Use a sweep speed that clearly shows the interval boundaries.
- Measure from the specified onset to offset.
- Average representative beats using consistent rhythm handling.

### R peak → e′ onset  ms

Spectral Doppler timing · Optional

- Use a sweep speed that clearly shows the interval boundaries.
- Measure from the specified onset to offset.
- Average representative beats using consistent rhythm handling.

### Mitral E  cm/s

PW Doppler at the mitral leaflet tips · Optional

- 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′  cm/s

PW tissue Doppler at the mitral annulus · Optional

- 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.

### Lateral e′  cm/s

PW tissue Doppler at the mitral annulus · Optional

- 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.

## Sources and method context

American Society of Echocardiography · 2025 · Evaluation of Left Ventricular Diastolic Function and HFpEF Diagnosis · Table 3 acquisition · Table 7 PDF p. 21 · MR section PDF p. 22

[Primary reference](https://www.asecho.org/wp-content/uploads/2025/07/Left-Ventricular-Diastolic-Function.pdf)

- Timing acquisition · Table 3 · PDF pp. 5, 7, 9

Same-beat CW IVRT, baseline Ar/A durations and matched ECG R-peak-to-onset E/e′ intervals.

- MR-specific indicators · Table 7 · PDF p. 21

IVRT, Ar−A duration, IVRT/T(E−e′), and restricted use of E/e′ when LVEF is depressed.

- MR limitations · Section 15A(b) · PDF p. 22

Effects of important MR on mitral and pulmonary-vein signals and the need for integrative 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.

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