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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

An integrated approach to the assessment of left ventricular diastolic function: Depressed 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 depressed LV ejection fraction (EF), it is reasonable to start with early and late transmitral diastolic inflow velocities and deceleration time (E, A and DT, respectively), as it can assumed that patients with depressed LVEF ( < 50%) have, by definition, impaired LV relaxation. Following transmitral diastolic flow, other echo-Doppler variables are added to result in an accurate assessment of LV diastolic function (From Reference [5]).
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fig6: An integrated approach to the assessment of left ventricular diastolic function: Depressed 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 depressed LV ejection fraction (EF), it is reasonable to start with early and late transmitral diastolic inflow velocities and deceleration time (E, A and DT, respectively), as it can assumed that patients with depressed LVEF ( < 50%) have, by definition, impaired LV relaxation. Following transmitral diastolic flow, other echo-Doppler variables are added to result in an accurate assessment of LV diastolic function (From Reference [5]).

Mentions: It is critical to integrate several variables—2-dimensional, conventional and tissue Doppler—in order to arrive at a correct diastolic assessment, as opposed to relying on a single variable (such as LA size or E/e′) alone which can lead to errors (Table 3). Indeed, current guideline recommend and integrated approach of many diastolic variables (Figures 5 and 6), and data has shown that additional echocardiographic variables, when added to E/e′ can result in more accurate diastolic determination, compared to invasively measured LV filling pressures, than E/e′ alone.36 Not infrequently, echo-Doppler parameters appear to conflict: for instance, in a patient with normal LVEF, E/e′ = 13, but LA volume is not enlarged, E < A, and there are normal pulmonary pressures by Doppler. In such cases, the E/e′ ratio should likely be dropped, since all other variables point toward normal LV filling pressures. Therefore, as rule, multiple echo-Doppler parameters of LV diastolic function should be assessed in every patient,37 and the conclusion to which most parameters point, should be the overall diastolic assessment, with “outlying” parameters discarded. In most cases of conflicting echo-Doppler diastolic parameters, a cogent conclusion can be reached, although in some cases, the diastolic assessment may remain equivocal. Above all, no single diastolic parameter should be used in isolation to arrive at a diastolic conclusion in a given patient.5


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: Depressed 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 depressed LV ejection fraction (EF), it is reasonable to start with early and late transmitral diastolic inflow velocities and deceleration time (E, A and DT, respectively), as it can assumed that patients with depressed LVEF ( < 50%) have, by definition, impaired LV relaxation. Following transmitral diastolic flow, 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

fig6: An integrated approach to the assessment of left ventricular diastolic function: Depressed 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 depressed LV ejection fraction (EF), it is reasonable to start with early and late transmitral diastolic inflow velocities and deceleration time (E, A and DT, respectively), as it can assumed that patients with depressed LVEF ( < 50%) have, by definition, impaired LV relaxation. Following transmitral diastolic flow, other echo-Doppler variables are added to result in an accurate assessment of LV diastolic function (From Reference [5]).
Mentions: It is critical to integrate several variables—2-dimensional, conventional and tissue Doppler—in order to arrive at a correct diastolic assessment, as opposed to relying on a single variable (such as LA size or E/e′) alone which can lead to errors (Table 3). Indeed, current guideline recommend and integrated approach of many diastolic variables (Figures 5 and 6), and data has shown that additional echocardiographic variables, when added to E/e′ can result in more accurate diastolic determination, compared to invasively measured LV filling pressures, than E/e′ alone.36 Not infrequently, echo-Doppler parameters appear to conflict: for instance, in a patient with normal LVEF, E/e′ = 13, but LA volume is not enlarged, E < A, and there are normal pulmonary pressures by Doppler. In such cases, the E/e′ ratio should likely be dropped, since all other variables point toward normal LV filling pressures. Therefore, as rule, multiple echo-Doppler parameters of LV diastolic function should be assessed in every patient,37 and the conclusion to which most parameters point, should be the overall diastolic assessment, with “outlying” parameters discarded. In most cases of conflicting echo-Doppler diastolic parameters, a cogent conclusion can be reached, although in some cases, the diastolic assessment may remain equivocal. Above all, no single diastolic parameter should be used in isolation to arrive at a diastolic conclusion in a given patient.5

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