Measured at end-systole* Use the biplane Simpson’s method from A4C and A2C views Image Acquisition Optimise view for the LA, even if the LV appears foreshortened Exclude pulmonary veins and the LA appendage from tracing Use the mitral annulus as the inferior border Reporting Indexed to body surface area = LAVi *End-Systole Measured at aortic valve closure — usually the frame with the smallest LV cavity size

RV Basal Diameter (RVD1) Measured at the widest transverse diameter of the basal third of the RV in end-diastole. RV Mid Diameter (RVD2) Measured at the level of the LV papillary muscles in end-diastole. RV Longitudinal Diameter (RVD3) Measured from the tricuspid annulus to the RV apex in end-diastole. RV-Focused A4C View All RV dimensions should be measured in the RV-focused apical 4-chamber view, not the standard A4C view. Obtain this by moving laterally and angling

E/e′ Ratio What does it tell you? E/e′ is a useful estimate of left ventricular filling pressure (LVFP) and left atrial pressure (LAP) Average E/e′ < 8: strongly suggests normal LV filling pressure Average E/e′ > 14: strongly suggests elevated LV filling pressure (*PCWP >15 mmHg) If only one annulus can be measured: Lateral E/e′ > 13 or Septal E/e′ > 15 - elevated filling pressures Physiology As diastolic dysfunction worsens: e′ decreases - impaired relaxation E increases - r