The diastolic mitral filling pattern has been named and graded umpteen times in the last decade. We believe it has reached some semblance of clarity.I beg to differ.
Image template taken from http://www.learntheheart.com
There need to be one more grade between Grade 1 and grade 2 .Grade 1 is defined as A velocity > E velocity . This is the commonest abnormal pattern and is often man made.We can’t help it . We have to report it anyway. Significant number of elderly show this pattern without any pathology. It simply represents augmented atrial contribution at times of apparent ventricular stress .
I wish a good chunk of grade 1 pattern , especially in elderly or during tachycardia should be labelled as physiological grade 1 pattern (or simply as normal variant ) . However I would prefer it to be named as pseudo abnormal pattern* !
* In my experience , currently medicine is taught in a complex manner .Facts that are told in simple terms are rejected straightaway . It would seem,too much clarity is not good for science So,let us get confused one more time for the sake of our patients !
Dr.S.Venkatesan MD 
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