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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

Tricuspid regurgitation velocity for pulmonary artery systolic pressure estimation in diastolic dysfunction: In patients with significant left ventricular (LV) diastolic dysfunction with chronically elevated LV filling pressures, back-pressure through the left atrium (LA), into the pulmonary veins, and across the pulmonary venous-capillary bed into the pulmonary arterioles and pulmonary arteries (PA), results in elevation of PA pressure. Thus, PA systolic pressure elevation, in the absence of significant intrinsic lung disease and resultant elevated pulmonary vascular resistance (PVR), is a reasonable correlate of elevated LA pressures. PA systolic pressure can be estimated by Doppler using the tricuspid regurgitation peak systolic velocity and adding to it an estimate of right atrial (RA) pressure. This image shows a TR velocity of 3.64 m/s, equivalent to a TR systolic pressure of 53 mmHg, which indicates at least moderate PA hypertension in patient with chronically elevated LA pressure due to ischemic cardiomyopathy and diastolic dysfunction. RV = right ventricular.
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fig4: Tricuspid regurgitation velocity for pulmonary artery systolic pressure estimation in diastolic dysfunction: In patients with significant left ventricular (LV) diastolic dysfunction with chronically elevated LV filling pressures, back-pressure through the left atrium (LA), into the pulmonary veins, and across the pulmonary venous-capillary bed into the pulmonary arterioles and pulmonary arteries (PA), results in elevation of PA pressure. Thus, PA systolic pressure elevation, in the absence of significant intrinsic lung disease and resultant elevated pulmonary vascular resistance (PVR), is a reasonable correlate of elevated LA pressures. PA systolic pressure can be estimated by Doppler using the tricuspid regurgitation peak systolic velocity and adding to it an estimate of right atrial (RA) pressure. This image shows a TR velocity of 3.64 m/s, equivalent to a TR systolic pressure of 53 mmHg, which indicates at least moderate PA hypertension in patient with chronically elevated LA pressure due to ischemic cardiomyopathy and diastolic dysfunction. RV = right ventricular.

Mentions: In the setting of high LA pressure in the patient with diastolic heart failure, pressure is transmitted back into the pulmonary veins, and across the pulmonary venous-capillary bed into the pulmonary arterioles and into the pulmonary arteries; therefore, pulmonary arterial hypertension (PAH) can result.27 In this way, PA pressure estimated by addition of an estimate of RA pressure (by assessing IVC size and response to respiration), is a good surrogate marker of significant, and often chronic, LA pressure elevation (Figure 4). As recommended by guidelines, PASP > 35 mmHg often accompanies advanced or significant LV diastolic dysfunction with elevated LA pressures.5 However, as with LA volume, the presence of significant PAH does not necessarily mean significant diastolic dysfunction, as significant elevations in pulmonary vascular resistance (PVR) due to intrinsic lung disease must first be excluded. Likewise, normal PASP can be helpful in excluding significant and long standing LA pressure elevation, provided a complete TR jet is obtained with correct Doppler sample volume angulation in respect of the direction of TR, and with correct RA pressure estimation. PA end-diastolic pressure, which in the absence of significant elevations in PVR can be a good estimate of mean LA pressure, can be estimated from the pulmonary regurgitation diastolic wave, with RA pressure then added to it as is done with PASP.28


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

Dokainish H - Glob Cardiol Sci Pract (2015)

Tricuspid regurgitation velocity for pulmonary artery systolic pressure estimation in diastolic dysfunction: In patients with significant left ventricular (LV) diastolic dysfunction with chronically elevated LV filling pressures, back-pressure through the left atrium (LA), into the pulmonary veins, and across the pulmonary venous-capillary bed into the pulmonary arterioles and pulmonary arteries (PA), results in elevation of PA pressure. Thus, PA systolic pressure elevation, in the absence of significant intrinsic lung disease and resultant elevated pulmonary vascular resistance (PVR), is a reasonable correlate of elevated LA pressures. PA systolic pressure can be estimated by Doppler using the tricuspid regurgitation peak systolic velocity and adding to it an estimate of right atrial (RA) pressure. This image shows a TR velocity of 3.64 m/s, equivalent to a TR systolic pressure of 53 mmHg, which indicates at least moderate PA hypertension in patient with chronically elevated LA pressure due to ischemic cardiomyopathy and diastolic dysfunction. RV = right ventricular.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig4: Tricuspid regurgitation velocity for pulmonary artery systolic pressure estimation in diastolic dysfunction: In patients with significant left ventricular (LV) diastolic dysfunction with chronically elevated LV filling pressures, back-pressure through the left atrium (LA), into the pulmonary veins, and across the pulmonary venous-capillary bed into the pulmonary arterioles and pulmonary arteries (PA), results in elevation of PA pressure. Thus, PA systolic pressure elevation, in the absence of significant intrinsic lung disease and resultant elevated pulmonary vascular resistance (PVR), is a reasonable correlate of elevated LA pressures. PA systolic pressure can be estimated by Doppler using the tricuspid regurgitation peak systolic velocity and adding to it an estimate of right atrial (RA) pressure. This image shows a TR velocity of 3.64 m/s, equivalent to a TR systolic pressure of 53 mmHg, which indicates at least moderate PA hypertension in patient with chronically elevated LA pressure due to ischemic cardiomyopathy and diastolic dysfunction. RV = right ventricular.
Mentions: In the setting of high LA pressure in the patient with diastolic heart failure, pressure is transmitted back into the pulmonary veins, and across the pulmonary venous-capillary bed into the pulmonary arterioles and into the pulmonary arteries; therefore, pulmonary arterial hypertension (PAH) can result.27 In this way, PA pressure estimated by addition of an estimate of RA pressure (by assessing IVC size and response to respiration), is a good surrogate marker of significant, and often chronic, LA pressure elevation (Figure 4). As recommended by guidelines, PASP > 35 mmHg often accompanies advanced or significant LV diastolic dysfunction with elevated LA pressures.5 However, as with LA volume, the presence of significant PAH does not necessarily mean significant diastolic dysfunction, as significant elevations in pulmonary vascular resistance (PVR) due to intrinsic lung disease must first be excluded. Likewise, normal PASP can be helpful in excluding significant and long standing LA pressure elevation, provided a complete TR jet is obtained with correct Doppler sample volume angulation in respect of the direction of TR, and with correct RA pressure estimation. PA end-diastolic pressure, which in the absence of significant elevations in PVR can be a good estimate of mean LA pressure, can be estimated from the pulmonary regurgitation diastolic wave, with RA pressure then added to it as is done with PASP.28

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