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Left ventricular diastolic function and dysfunction: Central role of echocardiography.

Dokainish H - Glob Cardiol Sci Pract (2015)

Bottom Line: Echocardiography with Doppler readily assesses LV diastolic function; advantages include that echocardiography is non-invasive, does not require radiation, is portable, rapid, readily available, and in competent hands, can provide an accurate and comprehensive assessment of LV systolic and diastolic function.Tissue Doppler (TD) imaging has been useful in demonstrating impaired LV relaxation in the setting of preserved LVEF, which, in the setting of increased cardiac volume, can result in elevated LV filling pressures, and dyspnea due to diastolic heart failure.TD imaging is not always critical in patients with depressed LVEF, since such patients by definition have impaired LV relaxation, and thus significant increases in volume will result in increases in LV filling pressure due to impaired LV compliance.

View Article: PubMed Central - PubMed

ABSTRACT
Comprehensive and precise assessment of left ventricular (LV) systolic and diastolic function is necessary to establish, or exclude, heart failure as a cause or component of dyspnea. Echocardiography with Doppler readily assesses LV diastolic function; advantages include that echocardiography is non-invasive, does not require radiation, is portable, rapid, readily available, and in competent hands, can provide an accurate and comprehensive assessment of LV systolic and diastolic function. Correct assessment of LV diastolic function is relevant in patients with both depressed and preserved LV ejection fraction (EF ≥ 50%, and < 50%, respectively). Tissue Doppler (TD) imaging has been useful in demonstrating impaired LV relaxation in the setting of preserved LVEF, which, in the setting of increased cardiac volume, can result in elevated LV filling pressures, and dyspnea due to diastolic heart failure. TD imaging is not always critical in patients with depressed LVEF, since such patients by definition have impaired LV relaxation, and thus significant increases in volume will result in increases in LV filling pressure due to impaired LV compliance. Thus, in depressed LVEF, transmitral flow velocities (E and A, and E/A) and deceleration time, pulmonary venous Doppler, left atrial volume, and pulmonary artery (PA) pressures suffice for the accurate assessment of LV filling pressures. Overall, diastolic assessment by echo-Doppler can be readily achieved in by using a comprehensive diastolic assessment-incorporating many 2-dimensional, conventional and tissue Doppler variables-as opposed to relying on any single, diastolic parameter, which can lead to errors.

No MeSH data available.


Related in: MedlinePlus

Comprehensive diastolic assessment with echocardiography in a patient with diastolic heart failure: Chronic hypertension is a common scenario for the development of diastolic dysfunction, and the hypertrophied left ventricle (LV) develops impaired relaxation, and in the right loading conditions, can result in elevated left atrial (LA) pressure. This patient with chronic hypertension presented with dyspnea. Echocardiography revealed concentric LV hypertrophy (LV mass index was 119 g/m2, Panel A) with preserved LV ejection fraction of 62%. The patient also has severely dilated left atrium (LA) from chronic elevation in LA pressures in the setting of left ventricular hypertrophy from chronic hypertension (Panel B). This patient had severe LA enlargement, with an unindexed LA volume of 137 ml and an indexed volume of 72 ml/m2. Panel C shows restrictive diastolic filling pattern in the transmitral spectral Doppler with E/A = 2.46 and deceleration time = 121 ms, reflective of significantly elevated LV filling pressures. Panel D shows tissue Doppler at the lateral LV mitral annulus with a depressed e′ velocity of 5.7 cm/s, indicating impaired LV relaxation; when e′ is divided into the transmitral E velocity of 177 cm/s, this results in an elevated E/e′ of 31, confirming significantly elevated LV filling pressures.
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fig1: Comprehensive diastolic assessment with echocardiography in a patient with diastolic heart failure: Chronic hypertension is a common scenario for the development of diastolic dysfunction, and the hypertrophied left ventricle (LV) develops impaired relaxation, and in the right loading conditions, can result in elevated left atrial (LA) pressure. This patient with chronic hypertension presented with dyspnea. Echocardiography revealed concentric LV hypertrophy (LV mass index was 119 g/m2, Panel A) with preserved LV ejection fraction of 62%. The patient also has severely dilated left atrium (LA) from chronic elevation in LA pressures in the setting of left ventricular hypertrophy from chronic hypertension (Panel B). This patient had severe LA enlargement, with an unindexed LA volume of 137 ml and an indexed volume of 72 ml/m2. Panel C shows restrictive diastolic filling pattern in the transmitral spectral Doppler with E/A = 2.46 and deceleration time = 121 ms, reflective of significantly elevated LV filling pressures. Panel D shows tissue Doppler at the lateral LV mitral annulus with a depressed e′ velocity of 5.7 cm/s, indicating impaired LV relaxation; when e′ is divided into the transmitral E velocity of 177 cm/s, this results in an elevated E/e′ of 31, confirming significantly elevated LV filling pressures.

Mentions: In patients with heart failure and preserved LVEF, LVEF is preserved ≥ 50%, yet, left atrial pressures—synonymous with LV filling pressures in the absence of obstructive MV disease—are elevated, causing increased pulmonary venous pressures and dyspnea at rest or during exertion.1–6 In order for LA pressures to be elevated in the absence of significantly depressed LVEF, LV relaxation and compliance generally are depressed, most often occurring in hypertensive or ischemic heart disease.2–5 2-dimensional echocardiography, therefore, identifies LV abnormalities that create the substrate for LV diastolic dysfunction: LV hypertrophy and LV wall motion abnormalities. Increased LV mass ( ≥ 90 g/m2 for women and ≥ 115 g/m2 for men, i.e. LV hypertrophy) is common in patients with DHF5 (Figure 1). Previous studies have correlated increasing degrees of LV mass with increasing LV diastolic dysfunction and filling pressures.8 In addition, since LVEF can be preserved even in presence of significant coronary artery disease, LV wall motion abnormalities create the substrate for significant LV diastolic dysfunction even in the patient with preserved LVEF who may have a diagnosis of DHF. Therefore, accurate identification of LV wall motion abnormalities is of great importance in the assessment of the patient with potential diastolic dysfunction. Since LA pressures are elevated in patients with significant diastolic dysfunction in the presence of increased preload, and since the LA cannot adequately empty in to the LV during diastole in this hemodynamic scenario, LA enlargement ( ≥ 30 ml/m2) is usually seen5 (Figure 1).


Left ventricular diastolic function and dysfunction: Central role of echocardiography.

Dokainish H - Glob Cardiol Sci Pract (2015)

Comprehensive diastolic assessment with echocardiography in a patient with diastolic heart failure: Chronic hypertension is a common scenario for the development of diastolic dysfunction, and the hypertrophied left ventricle (LV) develops impaired relaxation, and in the right loading conditions, can result in elevated left atrial (LA) pressure. This patient with chronic hypertension presented with dyspnea. Echocardiography revealed concentric LV hypertrophy (LV mass index was 119 g/m2, Panel A) with preserved LV ejection fraction of 62%. The patient also has severely dilated left atrium (LA) from chronic elevation in LA pressures in the setting of left ventricular hypertrophy from chronic hypertension (Panel B). This patient had severe LA enlargement, with an unindexed LA volume of 137 ml and an indexed volume of 72 ml/m2. Panel C shows restrictive diastolic filling pattern in the transmitral spectral Doppler with E/A = 2.46 and deceleration time = 121 ms, reflective of significantly elevated LV filling pressures. Panel D shows tissue Doppler at the lateral LV mitral annulus with a depressed e′ velocity of 5.7 cm/s, indicating impaired LV relaxation; when e′ is divided into the transmitral E velocity of 177 cm/s, this results in an elevated E/e′ of 31, confirming significantly elevated LV filling pressures.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4374097&req=5

fig1: Comprehensive diastolic assessment with echocardiography in a patient with diastolic heart failure: Chronic hypertension is a common scenario for the development of diastolic dysfunction, and the hypertrophied left ventricle (LV) develops impaired relaxation, and in the right loading conditions, can result in elevated left atrial (LA) pressure. This patient with chronic hypertension presented with dyspnea. Echocardiography revealed concentric LV hypertrophy (LV mass index was 119 g/m2, Panel A) with preserved LV ejection fraction of 62%. The patient also has severely dilated left atrium (LA) from chronic elevation in LA pressures in the setting of left ventricular hypertrophy from chronic hypertension (Panel B). This patient had severe LA enlargement, with an unindexed LA volume of 137 ml and an indexed volume of 72 ml/m2. Panel C shows restrictive diastolic filling pattern in the transmitral spectral Doppler with E/A = 2.46 and deceleration time = 121 ms, reflective of significantly elevated LV filling pressures. Panel D shows tissue Doppler at the lateral LV mitral annulus with a depressed e′ velocity of 5.7 cm/s, indicating impaired LV relaxation; when e′ is divided into the transmitral E velocity of 177 cm/s, this results in an elevated E/e′ of 31, confirming significantly elevated LV filling pressures.
Mentions: In patients with heart failure and preserved LVEF, LVEF is preserved ≥ 50%, yet, left atrial pressures—synonymous with LV filling pressures in the absence of obstructive MV disease—are elevated, causing increased pulmonary venous pressures and dyspnea at rest or during exertion.1–6 In order for LA pressures to be elevated in the absence of significantly depressed LVEF, LV relaxation and compliance generally are depressed, most often occurring in hypertensive or ischemic heart disease.2–5 2-dimensional echocardiography, therefore, identifies LV abnormalities that create the substrate for LV diastolic dysfunction: LV hypertrophy and LV wall motion abnormalities. Increased LV mass ( ≥ 90 g/m2 for women and ≥ 115 g/m2 for men, i.e. LV hypertrophy) is common in patients with DHF5 (Figure 1). Previous studies have correlated increasing degrees of LV mass with increasing LV diastolic dysfunction and filling pressures.8 In addition, since LVEF can be preserved even in presence of significant coronary artery disease, LV wall motion abnormalities create the substrate for significant LV diastolic dysfunction even in the patient with preserved LVEF who may have a diagnosis of DHF. Therefore, accurate identification of LV wall motion abnormalities is of great importance in the assessment of the patient with potential diastolic dysfunction. Since LA pressures are elevated in patients with significant diastolic dysfunction in the presence of increased preload, and since the LA cannot adequately empty in to the LV during diastole in this hemodynamic scenario, LA enlargement ( ≥ 30 ml/m2) is usually seen5 (Figure 1).

Bottom Line: Echocardiography with Doppler readily assesses LV diastolic function; advantages include that echocardiography is non-invasive, does not require radiation, is portable, rapid, readily available, and in competent hands, can provide an accurate and comprehensive assessment of LV systolic and diastolic function.Tissue Doppler (TD) imaging has been useful in demonstrating impaired LV relaxation in the setting of preserved LVEF, which, in the setting of increased cardiac volume, can result in elevated LV filling pressures, and dyspnea due to diastolic heart failure.TD imaging is not always critical in patients with depressed LVEF, since such patients by definition have impaired LV relaxation, and thus significant increases in volume will result in increases in LV filling pressure due to impaired LV compliance.

View Article: PubMed Central - PubMed

ABSTRACT
Comprehensive and precise assessment of left ventricular (LV) systolic and diastolic function is necessary to establish, or exclude, heart failure as a cause or component of dyspnea. Echocardiography with Doppler readily assesses LV diastolic function; advantages include that echocardiography is non-invasive, does not require radiation, is portable, rapid, readily available, and in competent hands, can provide an accurate and comprehensive assessment of LV systolic and diastolic function. Correct assessment of LV diastolic function is relevant in patients with both depressed and preserved LV ejection fraction (EF ≥ 50%, and < 50%, respectively). Tissue Doppler (TD) imaging has been useful in demonstrating impaired LV relaxation in the setting of preserved LVEF, which, in the setting of increased cardiac volume, can result in elevated LV filling pressures, and dyspnea due to diastolic heart failure. TD imaging is not always critical in patients with depressed LVEF, since such patients by definition have impaired LV relaxation, and thus significant increases in volume will result in increases in LV filling pressure due to impaired LV compliance. Thus, in depressed LVEF, transmitral flow velocities (E and A, and E/A) and deceleration time, pulmonary venous Doppler, left atrial volume, and pulmonary artery (PA) pressures suffice for the accurate assessment of LV filling pressures. Overall, diastolic assessment by echo-Doppler can be readily achieved in by using a comprehensive diastolic assessment-incorporating many 2-dimensional, conventional and tissue Doppler variables-as opposed to relying on any single, diastolic parameter, which can lead to errors.

No MeSH data available.


Related in: MedlinePlus