Conclusion
The assessment of LV diastolic dysfunction in patients with MS is challenging. Identification of concomitant diastolic disorders is imperative in the management of older subjects with co-existent systemic disease, co-morbidities and mismatch between symptom class and MVOA, and to identify subgroups that may not benefit from balloon intervention. Such subjects may benefit from optimal medical therapy to decrease blood pressure, lower heart rate, improve LV diastolic filling and with diuretics to lower PH. Conventional echocardiographic methods are of limited value to assess LV diastolic dysfunction in MS. IVRT/TE-e´ ratio is the recommended method to identify the presence of raised LV filling pressure. Newer diagnostic methods like speckle tracking echocardiography show promise, but widespread utility is currently limited owing to insufficient data.