Diastology: Use E/e’ to Estimate Left Atrial Pressure

Diastology: Use E/e’ to Estimate Left Atrial Pressure

From REBEL Cast by Salim R. Rezaie, MD

March 9, 2026

About this episode

This episode discusses the use of E/e’ to estimate left atrial pressure in emergency settings.

🧭 REBEL Rundown 📌 Key Points 🎯 POCUS diastology answers one ED question: Is left atrial pressure (LAP) elevated right now? (not “diagnose diastolic dysfunction”) 📈 E/e’ estimates LAP using mitral inflow E (PW Doppler) and annular e’ (TDI) from an apical 4-chamber view Interpretation: E/e’ ≥ 14 → likely elevated LAP (supports cardiogenic pulmonary edema); ≤ 8 → LAP likely normal; 8–14 → indeterminate ⚡ Fast + actionable: With a decent apical view, E and e’ can be captured in ~60 seconds to guide diuresis/afterload reduction vs non-cardiac pathways ⚠️ Use context: E/e’ performs best in reduced EF and can be confounded by MR/MS, tachycardia, and BiPAP/PEEP 📝 Introduction A formal echocardiographic diagnosis of diastolic dysfunction is multivariable, nuanced, and not an ED priority in most acute dyspnea cases. In the emergency setting, the bedside question that changes management is simpler: Is left atrial pressure (LAP) elevated right now? Elevated LAP is the physiologic substrate for cardiogenic pulmonary edema and the target for…

People in this episode

Host: Salim R. Rezaie, MD

Topics covered

  • diastology
  • left atrial pressure
  • POCUS
  • acute dyspnea
  • cardiogenic pulmonary edema

Keywords

  • E/e’
  • left atrial pressure
  • POCUS diastology
  • acute resuscitation
  • diastolic dysfunction

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