"1/15" I posted my method to investigate LV diastolic function and was questioned about two unusual aspects: 1) relaxation o LV was analyzed on a 2D PLAX view (how come?); 2) LA size was analyzed by eyeballing (eyeball ????????). Even though I explained in an extensive article.
"2/15" I made this thread to be better understood. Some necessary tenets: normally, 70% of the total diastolic volume reaches LV by the initial 1/3 of diastole, during the rapid filling phase, and 30% by the remaining 2/3. This relation is inverted when relaxation is abnormal. 
"3/15" During systole, mitral annulus is pulled in an apical direction. During diastole it recoils, just as an elastic rubber band, in response to its filling. Normally, 70% or close to 100% of its systolic pulling recoils during the initial 1/3 and just 30% or less at the end.
"4/15" In case of poor LV relaxation, just 30% or close to 0% of its systolic pulling recoils during the initial 1/3, and 70% or all the recoil is at the end. The difference between normal and abnormal relaxation is easily noted by eyeball. NO measuring is needed.
"5/15" Normal LV relax. Since you are evaluating a % of the patient's own systolic dislocation recoil, more at initial diastole than at the late, these events are easily noted. The patient's own systolic dislocation is the scale for the extension of the recoils. No measuring!
"6/15" Red arrow points AV annulus at the starting of systolic pulling. At the end of diastole, the annulus has to return to this point. It does almost immediately. The yellow arrow shows the anterior direction of the LA contraction. It would not be seen as well in apical views
"7/15" Athlete. Normal relaxation. Returns quickly during initial diastole to red arrow position. Important A wave during yellow arrow at end-diastole.
"8/15" Abnormal relaxation the annulus only returns to the original position (red arrow) at the end of diastole with the atrial contraction.
"9/15" Another abnormal relax. MV opens and there is almost no return of the annulus. It only returns with the atrial contraction. Notice that the velocity of return is not important, but the relation of initial or late diastole. Systolic pull distance is the gauge for return.
"10/15" Slow motion of the same patient. So obvious.
"11/15" Take home notice: 1) Eyeball is important and easy to learn, but only if TAUGHT like here, personally, it will never come to you by the articles. 2) NUMBERS ARE NOT always LAUDER. They're essential, but the problem is the cut-off maximal values, as I will demonstrate next
"12/15" 3) Next year (HAPPY NEW YEAR!) probably within the first week, another thread like this explaining the question: LA size eyeball (?????????) Yes, and you will see how. Meanwhile, see why eyeball is so IMPORTANT because of cut-off numbers. cardiomorcerf.com/universal-prob…
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