E/A Ratio Grading (Diastolic Function): Explanation and Clinical Context The E/A ratio is obtained from Doppler echocardiography by dividing the peak early (E) mitral inflow velocity by the peak atrial (A) contraction velocity. It is a cornerstone for evaluating left ventricular diastolic function.
Grade I (E/A < 0.8) represents impaired relaxation, commonly seen in early diastolic dysfunction and aging.
Grade II (E/A 0.8–2.0) indicates pseudonormal filling, where elevated left atrial pressures mask underlying relaxation abnormalities.
Grade III (E/A > 2.0) reflects restrictive filling, typically associated with advanced diastolic dysfunction and increased filling pressures, often correlating with worse prognosis.
This tool aids clinicians in identifying the severity of diastolic dysfunction, guiding management in heart failure with preserved ejection fraction (HFpEF) and other cardiac conditions.
Reference:
Nagueh SF, Smiseth OA, Appleton CP, et al. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2016;29:277-314. doi:10.1016/j.echo.2016.01.011