Management of Diastolic Dysfunction by Pharmacological Optimization of E-A Wave Synchrony and Morphology

Heart Failure is a major public health problem globally, affecting about 5.1 million patients in the US, almost 40% of whom have predominantly diastolic left ventricular (LV) dysfunction. Pulsed doppler echocardiography of the mitral inflow, in terms of E-A ratio, is used in the assessment of diastolic function. Besides E-A ratio, optimization of E-A wave synchrony and morphology has also been shown to improve diastolic filling and cardiac hemodynamics in patients with cardiac implantable electronic devices (CIED). In this case report, we applied the principles of echocardiographic AV optimization in CIED patients to patients without CIEDs by pharmacological intervention to improve LV diastolic function.