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Diastolic Dysfunction Grading — EECC MCQ

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ModerateHeart FailureDiastolic Dysfunction GradingEECC

A 68-year-old woman with HFpEF (LVEF 55%), obesity (BMI 36), and persistent AF has raised filling pressures confirmed by elevated E/e' ratio (18), enlarged left atrium (LAVi 48 mL/m²), and elevated NT-proBNP (1,400 pg/mL). Her echocardiographer reports 'grade III diastolic dysfunction.' What does grade III diastolic dysfunction indicate?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Restrictive filling pattern with elevated LV filling pressures that is associated with worse prognosis

Explanation lettering: B = shown as A · C = shown as B · E = shown as C · A = shown as E

Diastolic dysfunction is graded by the ASE/EACVI 2016 guidelines: Grade I = impaired relaxation (E/A <0.8, normal filling pressures); Grade II = pseudonormal (E/A 0.8-2.0 with elevated filling pressures, 'unmasked' by Valsalva); Grade III = restrictive filling (E/A ≥2.0, very short E deceleration time, elevated E/e' and LA pressure). Grade III indicates severely elevated LV filling pressures with a restrictive physiology, carrying the worst prognosis. In HFpEF, diastolic dysfunction severity is a key prognostic determinant. The elevated E/e' (>14), enlarged LA (LAVi >34 mL/m²), and high NT-proBNP all confirm elevated filling pressures consistent with this grading.

Reference: ASE/EACVI 2016 Diastolic Function Guidelines; ESC (2023): HF Guidelines