Representative echocardiographic images from a patient with sickle cell disease. (A) Apical 4-chamber view showing concentric left ventricular hypertrophy and a dilated left atrium. (B) Doppler of the mitral inflow used to obtain a peak E velocity for early ventricular filling. (C) Tissue Doppler of the lateral mitral annulus used to obtain a peak e′ velocity. The E/e′ ratio is an indicator of left ventricular filling pressures and is used in the assessment of diastolic dysfunction.