LV diastolic function grading and LAP estimation: sinus rhythm (ASE 2025 Figure 3)

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LV diastolic function grading and LAP estimation: sinus rhythm (ASE 2025 Figure 3)

Version 2026.10.1

Stepwise estimation of mean LAP and diastolic function grade in patients in sinus rhythm from e′, E/e′, TR velocity/PASP, E/A and the additional and supplemental variables. Diastolic function grade and estimated LAP are separate outputs.

Quick reference:↑ Diastolic function and filling pressures

Flowchart:

Applicability

Patients in sinus rhythm irrespective of LVEF, except the special populations: severe primary MR, any mitral stenosis, moderate/severe MAC, mitral repair/replacement/TEER, heart transplant, LVAD, noncardiac PH, pericardial constriction, and the cases in the special-population sections.
Atrial fibrillation is never graded with this pathway; use the AF algorithm (Figure 8). Not for children, normal pregnancy or the intraoperative setting.
Missing or unreliable variables stop the trace as incomplete or indeterminate; a suboptimal signal is not used and no conclusion rests on a single measurement.

Figure 3 caption / exceptions box
Is the patient in sinus rhythm and free of the conditions excluded from Figure 3?
Rhythm — Atrial fibrillation or flutter uses the AF pathway (Figure 8); the sinus-rhythm algorithm is never applied to AF.Special population — Select the condition that applies; the special-population pathway gives the document’s guidance.
Confirm the rhythm: Figure 3 applies to patients in sinus rhythm only.