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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

Diastolic function grades: Left ventricular (LV) diastolic function ranges from normal (Grade 0) to impaired relaxation (Grade I), to pseudonormal (Grade II), to restrictive (Grade III), and irreversibly restrictive (Grade IV). LV relaxation and left atrial pressures (LAp) increase from Grades 0 to IV, as does LA volume. Mitral valve inflow (MVI), tissue Doppler imaging, Valsalva manoeuver, flow propagation velocity (Vp) and pulmonary venous flow are all helpful in distinguishing Grades of LV diastolic function, and should be used together for an integrated approach to the assessment of diastolic function as recommended in current guidelines (Figure adapted from Reference [31]).
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fig2: Diastolic function grades: Left ventricular (LV) diastolic function ranges from normal (Grade 0) to impaired relaxation (Grade I), to pseudonormal (Grade II), to restrictive (Grade III), and irreversibly restrictive (Grade IV). LV relaxation and left atrial pressures (LAp) increase from Grades 0 to IV, as does LA volume. Mitral valve inflow (MVI), tissue Doppler imaging, Valsalva manoeuver, flow propagation velocity (Vp) and pulmonary venous flow are all helpful in distinguishing Grades of LV diastolic function, and should be used together for an integrated approach to the assessment of diastolic function as recommended in current guidelines (Figure adapted from Reference [31]).

Mentions: Transmitral Doppler (“mitral inflow pattern”) is essential for the assessment of LV filling pressures. Early mitral filling depends on intrinsic LV relaxation, and the difference between LA and LV early (or “opening”) diastolic pressure.5 In a healthy, young heart with normal, rapid diastolic suction, the LV literally “sucks” blood into the LV, resulting in rapid LA emptying. In this scenario, there is a relatively tall E wave, and a shorter A (late diastolic or “atrial contraction” wave) (Figure 3). In an LV with impaired relaxation but normal LV filling pressures, there is no rapid LV diastolic suction, thus LA emptying is more gradual, and results in a relatively low velocity E wave; LA emptying is therefore dependent on LA contraction, and results in a relatively high amplitude A wave. In the setting of impaired LV relaxation and mildly elevated LA pressure, high LA pressure that “drives” open the MV, resulting in a large E wave and smaller A wave; this pattern is termed “pseudonormalization”. In markedly elevated LV filling pressure in which LV stiffness is high, the MV is forced open early due to high LA pressure, but there is rapid equilibration with the high resting LV diastolic pressure resulting in a rapid deceleration time of E. This pattern is termed “restrictive filling” (Figure 1).3–5 The grades of diastolic function, as assessed using comprehensive echo-Doppler examination, are shown in Figure 2.


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

Dokainish H - Glob Cardiol Sci Pract (2015)

Diastolic function grades: Left ventricular (LV) diastolic function ranges from normal (Grade 0) to impaired relaxation (Grade I), to pseudonormal (Grade II), to restrictive (Grade III), and irreversibly restrictive (Grade IV). LV relaxation and left atrial pressures (LAp) increase from Grades 0 to IV, as does LA volume. Mitral valve inflow (MVI), tissue Doppler imaging, Valsalva manoeuver, flow propagation velocity (Vp) and pulmonary venous flow are all helpful in distinguishing Grades of LV diastolic function, and should be used together for an integrated approach to the assessment of diastolic function as recommended in current guidelines (Figure adapted from Reference [31]).
© Copyright Policy - open-access
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4374097&req=5

fig2: Diastolic function grades: Left ventricular (LV) diastolic function ranges from normal (Grade 0) to impaired relaxation (Grade I), to pseudonormal (Grade II), to restrictive (Grade III), and irreversibly restrictive (Grade IV). LV relaxation and left atrial pressures (LAp) increase from Grades 0 to IV, as does LA volume. Mitral valve inflow (MVI), tissue Doppler imaging, Valsalva manoeuver, flow propagation velocity (Vp) and pulmonary venous flow are all helpful in distinguishing Grades of LV diastolic function, and should be used together for an integrated approach to the assessment of diastolic function as recommended in current guidelines (Figure adapted from Reference [31]).
Mentions: Transmitral Doppler (“mitral inflow pattern”) is essential for the assessment of LV filling pressures. Early mitral filling depends on intrinsic LV relaxation, and the difference between LA and LV early (or “opening”) diastolic pressure.5 In a healthy, young heart with normal, rapid diastolic suction, the LV literally “sucks” blood into the LV, resulting in rapid LA emptying. In this scenario, there is a relatively tall E wave, and a shorter A (late diastolic or “atrial contraction” wave) (Figure 3). In an LV with impaired relaxation but normal LV filling pressures, there is no rapid LV diastolic suction, thus LA emptying is more gradual, and results in a relatively low velocity E wave; LA emptying is therefore dependent on LA contraction, and results in a relatively high amplitude A wave. In the setting of impaired LV relaxation and mildly elevated LA pressure, high LA pressure that “drives” open the MV, resulting in a large E wave and smaller A wave; this pattern is termed “pseudonormalization”. In markedly elevated LV filling pressure in which LV stiffness is high, the MV is forced open early due to high LA pressure, but there is rapid equilibration with the high resting LV diastolic pressure resulting in a rapid deceleration time of E. This pattern is termed “restrictive filling” (Figure 1).3–5 The grades of diastolic function, as assessed using comprehensive echo-Doppler examination, are shown in Figure 2.

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