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The clinical quandary of left and right ventricular diastolic dysfunction and diastolic heart failure.

Schwarz ER, Dashti R - Cardiovasc J Afr (2010 Jul-Aug)

Bottom Line: The abnormal relaxation is usually separated in different degrees, based on the severity of reduction in passive compliance and active myocardial relaxation.Treatment recommendations for diastolic heart failure are primarily targeted at risk reduction and symptom relief.Currently, few data only are reported on diastolic dysfunction and its progression to systolic heart failure.

View Article: PubMed Central - HTML - PubMed

Affiliation: Cedars Sinai Heart Institute, Cedars-Sinai Medical Center and University of California Los Angeles (UCLA), Los Angeles, California, USA. ernst.schwarz@cshs.org

ABSTRACT
Diastolic heart failure is a common clinical entity that is indistinguishable from systolic heart failure without direct evaluation of left ventricular function. Diastolic heart failure is a clinical diagnosis in patients with signs and symptoms of heart failure but with preserved left ventricular function and normal ejection fraction, and is often seen in patients with a long-standing history of hypertension or infiltrative cardiac diseases. In contrast, diastolic dysfunction represents a mechanical malfunction of the relaxation of the left ventricular chamber that is primarily diagnosed by two-dimensional transthoracic echocardiography and usually does not present clinically as heart failure. The abnormal relaxation is usually separated in different degrees, based on the severity of reduction in passive compliance and active myocardial relaxation. The question whether diastolic dysfunction ultimately will lead to diastolic heart failure is critically reviewed, based on data from the literature. Treatment recommendations for diastolic heart failure are primarily targeted at risk reduction and symptom relief. Currently, few data only are reported on diastolic dysfunction and its progression to systolic heart failure.

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Doppler tissue imaging (DTI ): E¢ < 7 indicates restrictive filling pattern. The E/E¢ > 15 suggests elevated PCWP.
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Figure 6: Doppler tissue imaging (DTI ): E¢ < 7 indicates restrictive filling pattern. The E/E¢ > 15 suggests elevated PCWP.

Mentions: Based on the echocardiographic parameters, diastolic dysfunction has been divided into three different grades of severity of ventricular compliance, relaxation rate and filling pressures.8 Stage one is the mildest form of diastolic dysfunction with delayed relaxation defined by an early filling to late or atrial filling (E/A) ratio less than 1, prolonged IVRT and prolonged DT. The systolic to diastolic pulmonary venous (S/D) ratio is greater than 1 (Fig. 3). Stage two is marked by a moderate level of dysfunction and defined by E/A of greater than 1 and/or greater than 2 with S/D less than 1, and is often called pseudonormalisation (with a normal diastolic filling pattern), caused by elevated left atrial pressures. This can be unmasked by reducing preload, for example by use of the Valsalva manoeuvre or application of sublingual nitroglycerine (Fig. 4). Stage three is marked by a restrictive filling pattern and signifies severe diastolic dysfunction, i.e. decreased compliance and marked increase in left atrial pressure. The E/A is greater than 2, IVRT and DT are short, and S/D is less than 1 (Fig. 5). The mitral A duration is shorter than the PVa duration (Fig. 6).


The clinical quandary of left and right ventricular diastolic dysfunction and diastolic heart failure.

Schwarz ER, Dashti R - Cardiovasc J Afr (2010 Jul-Aug)

Doppler tissue imaging (DTI ): E¢ < 7 indicates restrictive filling pattern. The E/E¢ > 15 suggests elevated PCWP.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3721873&req=5

Figure 6: Doppler tissue imaging (DTI ): E¢ < 7 indicates restrictive filling pattern. The E/E¢ > 15 suggests elevated PCWP.
Mentions: Based on the echocardiographic parameters, diastolic dysfunction has been divided into three different grades of severity of ventricular compliance, relaxation rate and filling pressures.8 Stage one is the mildest form of diastolic dysfunction with delayed relaxation defined by an early filling to late or atrial filling (E/A) ratio less than 1, prolonged IVRT and prolonged DT. The systolic to diastolic pulmonary venous (S/D) ratio is greater than 1 (Fig. 3). Stage two is marked by a moderate level of dysfunction and defined by E/A of greater than 1 and/or greater than 2 with S/D less than 1, and is often called pseudonormalisation (with a normal diastolic filling pattern), caused by elevated left atrial pressures. This can be unmasked by reducing preload, for example by use of the Valsalva manoeuvre or application of sublingual nitroglycerine (Fig. 4). Stage three is marked by a restrictive filling pattern and signifies severe diastolic dysfunction, i.e. decreased compliance and marked increase in left atrial pressure. The E/A is greater than 2, IVRT and DT are short, and S/D is less than 1 (Fig. 5). The mitral A duration is shorter than the PVa duration (Fig. 6).

Bottom Line: The abnormal relaxation is usually separated in different degrees, based on the severity of reduction in passive compliance and active myocardial relaxation.Treatment recommendations for diastolic heart failure are primarily targeted at risk reduction and symptom relief.Currently, few data only are reported on diastolic dysfunction and its progression to systolic heart failure.

View Article: PubMed Central - HTML - PubMed

Affiliation: Cedars Sinai Heart Institute, Cedars-Sinai Medical Center and University of California Los Angeles (UCLA), Los Angeles, California, USA. ernst.schwarz@cshs.org

ABSTRACT
Diastolic heart failure is a common clinical entity that is indistinguishable from systolic heart failure without direct evaluation of left ventricular function. Diastolic heart failure is a clinical diagnosis in patients with signs and symptoms of heart failure but with preserved left ventricular function and normal ejection fraction, and is often seen in patients with a long-standing history of hypertension or infiltrative cardiac diseases. In contrast, diastolic dysfunction represents a mechanical malfunction of the relaxation of the left ventricular chamber that is primarily diagnosed by two-dimensional transthoracic echocardiography and usually does not present clinically as heart failure. The abnormal relaxation is usually separated in different degrees, based on the severity of reduction in passive compliance and active myocardial relaxation. The question whether diastolic dysfunction ultimately will lead to diastolic heart failure is critically reviewed, based on data from the literature. Treatment recommendations for diastolic heart failure are primarily targeted at risk reduction and symptom relief. Currently, few data only are reported on diastolic dysfunction and its progression to systolic heart failure.

Show MeSH
Related in: MedlinePlus