<icirculation>:
What do you think should be the gold-standard to evaluate diastolic heart failure?

Sanderson
The gold-standard to measure diastolic dysfunction is very， very debatable.   Certainly the old invasive methods， such as end-diastolic pressure volume relationships， I think are not accurate and often misleading.  I think a combination of echo measurements is probably the best we have， such as left atrial volume， E’， or the ratio of E/E’ and newer measurements such as strain may also be very useful.  But at the moment we can’t actually say ‘this is the gold-standard’， and I think we have to use a combination of measurements; not only at rest， but also at exercise.