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Figure 3 Echocardiographic Doppler grades of diastolic function based on mitral inflow patterns (30). Impaired relaxation (grade 1) results from impairments in active relaxation (prolonged tau) but is not associated with a change in mean left atrial pressure. Further grades of diastolic dysfunction by echocardiographic Doppler (grades 2 [pseudonormal] and 3 [restrictive]) are associated with an increased mean left atrial pressure. However, as depicted by the representative pressure-volume loops (bottom right), there is no shift in the end-diastolic pressure (EDP)-volume relationship, indicating that changes in Doppler filling patterns can be independent of alterations in the intrinsic passive diastolic properties of the left ventricle (LV). These curves are readily obtainable from a time-varying elastance-based simulation of the cardiovascular system. LVP = left ventricular pressure; LVV = left ventricular volume.