Reprinted from the Journal of the American Society of Echocardiography 22 (2):107–133, February 2009. With permission from and copyright 2009 by the American Society of Echocardiography.
Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography
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Keywords: Diastole; Echocardiography; Doppler; Heart failure
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Preface |
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The assessment of left ventricular (LV) diastolic function should be an integral part of a routine examination, particularly in patients presenting with dyspnea or heart failure. About half of patients with new diagnoses of heart failure have normal or near normal global ejection fractions (EFs). These patients are diagnosed with "diastolic heart failure" or "heart failure with preserved EF."1 The assessment of LV diastolic function and filling pressures is of paramount clinical importance to distinguish this syndrome from other diseases such as pulmonary disease resulting in dyspnea, to assess prognosis, and to identify underlying cardiac disease and its best treatment.
LV filling pressures as measured invasively include mean pulmonary wedge pressure or mean left atrial (LA) pressure (both in the absence of mitral stenosis), LV end-diastolic pressure (LVEDP; the pressure at the onset of the QRS complex or after A-wave pressure), and pre-A LV diastolic pressure (Figure 1).Although these
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I. Physiology |
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II. Morphologic and Functional Correlates of Diastolic Dysfunction |
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A. LV Hypertrophy
B. LA Volume
C. LA Function
D. Pulmonary Artery Systolic and Diastolic Pressures
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III. Mitral Inflow |
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A. Acquisition and Feasibility
B. Measurements
C. Normal Values
D. Inflow Patterns and Hemodynamics
E. Clinical Application to Patients With Depressed and Normal EFs
F. Limitations
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IV. Valsalva Maneuver |
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A. Performance and Acquisition
B. Clinical Application
C. Limitations
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V. Pulmonary Venous Flow |
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A. Acquisition and Feasibility
B. Measurements
C. Hemodynamic Determinants
D. Normal Values
E. Clinical Application to Patients With Depressed and Normal EFs
F. Limitations
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VI. Color M-Mode Flow Propagation Velocity |
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A. Acquisition, Feasibility, and Measurement
B. Hemodynamic Determinants
C. Clinical Application
D. Limitations
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VII. Tissue Doppler Annular Early and Late Diastolic Velocities |
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A. Acquisition and Feasibility
B. Measurements
C. Hemodynamic Determinants
D. Normal Values
E. Clinical Application
F. Limitations
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VIII. Deformation Measurements |
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IX. Left Ventricular Untwisting |
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A. Clinical Application
B. Limitations
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X. Estimation of Left Ventricular Relaxation |
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A. Direct Estimation
1. IVRT
2. Aortic regurgitation CW signal
3. MR CW signal
B. Surrogate Measurements
1. Mitral inflow velocities
2. Tissue Doppler annular signals
3. Color M-Mode Vp
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XI. Estimation of Left Ventricular Stiffness |
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A. Direct estimation
B. Surrogate Measurements
1. DT of mitral E velocity
2. A-Wave transit time
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XII. Diastolic Stress Test |
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XIII. Other Reasons for Heart Failure Symptoms in Patients with Normal Ejection Fractions |
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A. Pericardial Diseases
B. Mitral Stenosis
C. MR
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XIV. Estimation of Left Ventricular Filling Pressures in Special Populations (Table 4) |
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A. Atrial Fibrillation
B. Sinus Tachycardia
C. Restrictive Cardiomyopathy
D. Hypertrophic Cardiomyopathy
E. Pulmonary Hypertension
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XV. Prognosis |
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XVI. Recommendations for Clinical Laboratories |
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A. Estimation of LV Filling Pressures in Patients With Depressed EFs
B. Estimation of LV Filling Pressures in Patients With Normal EFs
C. Grading Diastolic Dysfunction
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XVII. Recommendations for Application in Research Studies and Clinical Trials |
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