Which Doppler finding is most consistent with grade 1 diastolic dysfunction (impaired relaxation)?

• A. E/A ratio less than 1
• B. E/A ratio greater than 2
• C. Elevated E velocity with reduced A velocity
• D. Large V wave in pulmonary venous flow

Answer: (A)

In impaired relaxation (grade 1 diastolic dysfunction), the ventricle doesn’t fill quickly during early diastole, so early filling (E) is reduced while atrial contraction (A) becomes more important for filling. This yields a mitral inflow pattern where the E velocity is smaller than the A velocity, giving an E/A ratio less than 1. This pattern reflects normal or near-normal pressures but disturbed relaxation.

Therefore, the finding of E/A ratio below 1 best fits grade 1 diastolic dysfunction. Higher E/A ratios (greater than 2) point to restrictive filling seen in more advanced dysfunction, an elevated E with reduced A isn’t characteristic of the impaired-relaxation pattern, and a large V wave in pulmonary venous flow indicates higher left atrial pressures typical of later stages.