LV diastolic function guideline published

Published 03/06/2024

The British Society of Echocardiography (BSE) is delighted to announce the publication of a new left ventricular diastolic function guideline.

Since the previous guideline was released in 2013, there have been significant advances in the echocardiographic assessment of LV diastolic function with a greater understanding of how the diastolic investigation is subtly but importantly different between certain patient groups. Consequently, the BSE diastolic guidance no longer recommends a single algorithm for all patients and instead recommends patient-specific assessment according to global LV function and heart rhythm.

The guideline explains normal and abnormal anatomy and function of the left atrium and left ventricle before describing the key echocardiographic variables for assessing LV diastolic function. Three diastolic algorithms are presented for the patient groups of: normal LV systolic function, impaired LV systolic function or known myocardial disease, and atrial fibrillation. The guideline goes on to describe the diastolic stress echo and how to perform a diastolic assessment during exercise before highlighting special patient groups in which the standard diastolic assessment is not recommended. The guideline concludes with a consideration of emerging concepts and how diastolic guidelines might look in the future.

This guideline describes the assessment of intrinsic LV myocardial diastolic function and therefore does not cover the effects of pericardial constraint (constrictive or effusive).

Key changes include:

  • Updated diastolic assessment algorithms with key recommendations for specific patient groups
  • Recommendations for the assessment of LA strain analysis
  • Guidance for performing diastolic stress echocardiography

The core parameters within the updated diastolic algorithms reflect global practice while the addition of LA strain analysis is currently novel within international guidance.

So, what does this mean for practicing echocardiographers? Although the core parameters of the diastolic assessment remain unchanged, the inclusion of LA strain analysis, a previously non-routine parameter, will require additional training for some staff who are currently unfamiliar with the technique. This guideline also links closely with heart failure services so some communication with heart failure teams may be required.

This guideline will be published in the BSE’s official journal, Echo Research and Practice. Mr Shaun Robinson, Consultant Clinical Scientist at Imperial College Healthcare NHS Trust and lead author said, "By combining detailed descriptions of left ventricular anatomy and physiology with the latest scientific evidence-base, this new BSE guideline provides both education and clinical guidance for the assessment of left ventricular diastolic function. It is therefore a highly valuable resource for early-career and experienced echocardiographers alike."

Professor Dan Augustine, President said, "Heart failure with a normal ejection fraction is a major (and increasing) cause of morbidity and mortality. Anything that we can do to improve the detection and standardisation of reporting will benefit our patients. Echocardiography is the number one imaging modality used in the assessment of diastolic function worldwide and we have been lucky to have Mr Shaun Robinson (first author) and Professor Otto Smiseth (senior author) leading this BSE guideline. This contemporary evidence based guideline advances our current practice to the next level, taking into account LV function and atrial fibrillation. Importantly, standardisation of reporting phrases has been included so we can try to convey structured, similar messages to the referring clinician. This has been the biggest guideline project that we have undertaken and I’d like to thank all authors, in particularly Shaun who has worked tirelessly to see this through."

Read the guideline

We've also released a poster, detailing the key elements of the new guideline.

Find out more

Interested in finding out more about this new guideline? BSEcho 2024 will include a diastolic function workshop hosted by Mr Shaun Robinson.

Register for BSEcho 2024