Which imaging modality is most commonly used to quantify diastolic dysfunction and LV filling pressures?

• A. Cardiac MRI with edema mapping.
• B. Echocardiography with Doppler assessment (E/A, E/e' ratios).
• C. Nuclear perfusion imaging.
• D. CT calcium scoring.

Answer: (B)

Doppler echocardiography is the most practical way to quantify diastolic dysfunction and LV filling pressures because it provides real-time, noninvasive measurements of how blood flows through the mitral valve and how the ventricle relaxes. The E wave shows early passive filling, while the A wave reflects atrial contraction. In diastolic dysfunction, relaxation is impaired and the pattern of these inflow waves changes, with the E/A ratio shifting as filling pressures rise. The tissue Doppler velocity of the mitral annulus (e') gives a direct sense of myocardial relaxation, and the E/e' ratio combines these measures to estimate LV filling pressure: an elevated E/e' indicates higher pressures. This approach is widely available, safe, and repeatable, making it the standard method to quantify diastolic dysfunction and LV filling pressures. Other imaging modalities exist, but they’re not as well suited for this specific assessment—MRI can assess relaxation and structure but is less routinely used for filling pressures, while nuclear perfusion imaging and CT calcium scoring focus on perfusion or atherosclerosis rather than diastolic pressures.