Limits...
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

An integrated approach to the assessment of left ventricular diastolic function: Normal LV ejection fraction: As recommended in current guidelines, use of multiple echo-Doppler parameters results in a more accurate assessment of left ventricular (LV) diastolic function than using any single echo-Doppler parameter in isolation. In the patient with normal LV ejection fraction (EF), it is reasonable to start with early transmitral diastolic velocity/tissue Doppler early diastolic velocity (E/e′), as it can be difficult to discern whether a patient with preserved LVEF has impaired or normal LV relaxation. Following E/e′, other echo-Doppler variables are added to result in an accurate assessment of LV diastolic function (From Reference [5]).
© Copyright Policy - open-access
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4374097&req=5

fig5: An integrated approach to the assessment of left ventricular diastolic function: Normal LV ejection fraction: As recommended in current guidelines, use of multiple echo-Doppler parameters results in a more accurate assessment of left ventricular (LV) diastolic function than using any single echo-Doppler parameter in isolation. In the patient with normal LV ejection fraction (EF), it is reasonable to start with early transmitral diastolic velocity/tissue Doppler early diastolic velocity (E/e′), as it can be difficult to discern whether a patient with preserved LVEF has impaired or normal LV relaxation. Following E/e′, other echo-Doppler variables are added to result in an accurate assessment of LV diastolic function (From Reference [5]).

Mentions: The Valsalva manoeuver, in which the patient forces expiration against a closed glottis, there is increased intrathoracic pressure which results in decrease in right heart filling which by definition, results in decreased LV filling (decreased preload). Since a pseudonormal filling pattern exists in the setting of elevated LA pressure in the presence of impaired LV relaxation, this decrease in preload lowers LA pressure, which then “unmasks” the underlying impaired relaxation pattern (that is, E>A in the setting of impaired relaxation and with Valsalva manoeuver changes the transmitral pattern to E < A) (Figure 5). On the other hand, in the setting of normal diastolic function, the decrease in preload resulting from the Valsalva manoeuver preserves the E>A pattern, without changing it to E < A. Therefore, one of the main uses of the Valsalva manoeuver—similar to tissue Doppler e′—is to help distinguish normal from pseudonormal filling pattern. In the presence of a restrictive filling pattern, the Valsalva manoeuver will decrease preload and therefore help distinguish irreversible restrictive filling pattern (in which E≫A will not change) from reversible restrictive filling, where decreased preload changes the restrictive filling pattern to either pseudonormal (E>A) or impaired relaxation pattern (E < A), since the increased intrathoracic pressure resulting from Valsalva decreases LA pressure.


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

Dokainish H - Glob Cardiol Sci Pract (2015)

An integrated approach to the assessment of left ventricular diastolic function: Normal LV ejection fraction: As recommended in current guidelines, use of multiple echo-Doppler parameters results in a more accurate assessment of left ventricular (LV) diastolic function than using any single echo-Doppler parameter in isolation. In the patient with normal LV ejection fraction (EF), it is reasonable to start with early transmitral diastolic velocity/tissue Doppler early diastolic velocity (E/e′), as it can be difficult to discern whether a patient with preserved LVEF has impaired or normal LV relaxation. Following E/e′, other echo-Doppler variables are added to result in an accurate assessment of LV diastolic function (From Reference [5]).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig5: An integrated approach to the assessment of left ventricular diastolic function: Normal LV ejection fraction: As recommended in current guidelines, use of multiple echo-Doppler parameters results in a more accurate assessment of left ventricular (LV) diastolic function than using any single echo-Doppler parameter in isolation. In the patient with normal LV ejection fraction (EF), it is reasonable to start with early transmitral diastolic velocity/tissue Doppler early diastolic velocity (E/e′), as it can be difficult to discern whether a patient with preserved LVEF has impaired or normal LV relaxation. Following E/e′, other echo-Doppler variables are added to result in an accurate assessment of LV diastolic function (From Reference [5]).
Mentions: The Valsalva manoeuver, in which the patient forces expiration against a closed glottis, there is increased intrathoracic pressure which results in decrease in right heart filling which by definition, results in decreased LV filling (decreased preload). Since a pseudonormal filling pattern exists in the setting of elevated LA pressure in the presence of impaired LV relaxation, this decrease in preload lowers LA pressure, which then “unmasks” the underlying impaired relaxation pattern (that is, E>A in the setting of impaired relaxation and with Valsalva manoeuver changes the transmitral pattern to E < A) (Figure 5). On the other hand, in the setting of normal diastolic function, the decrease in preload resulting from the Valsalva manoeuver preserves the E>A pattern, without changing it to E < A. Therefore, one of the main uses of the Valsalva manoeuver—similar to tissue Doppler e′—is to help distinguish normal from pseudonormal filling pattern. In the presence of a restrictive filling pattern, the Valsalva manoeuver will decrease preload and therefore help distinguish irreversible restrictive filling pattern (in which E≫A will not change) from reversible restrictive filling, where decreased preload changes the restrictive filling pattern to either pseudonormal (E>A) or impaired relaxation pattern (E < A), since the increased intrathoracic pressure resulting from Valsalva decreases LA pressure.

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