Echo-Doppler evaluation of left ventricular diastolic dysfunction during acute myocardial infarction: methodological, clinical and prognostic implications

Abstract

Left ventricular (LV) diastolic dysfunction has been reported in the subacute and late phase after myocardial infarction and it is becoming increasingly clear that abnormalities of diastolic function during acute myocardial infarction (AMI) have a major role in affecting the prognosis. However, until recent years the study of patients with diastolic dysfunction has suffered from the substantial difficulties inherent in diagnosing, measuring, quantitating and in following it over time. Moreover, the complexity of events encompassed by diastole, which are often difficult to control in the clinical arena, and the lack of data available to guide therapy, have hampered the widespread application of diastology in the clinical setting of AMI. The advent of Doppler echocardiography and its complementary techniques have provided a bedside tool which yields reliable and useful measures of diastolic performance during AMI, placing such an assessment well within the grasp of every clinical echocardiographic laboratory. Determination of the pattern of LV filling by Doppler echocardiography provides important information about LV diastolic function in AMI patients. Clinical data gathered so far demonstrate that Doppler-derived LV filling, specifically the restrictive filling pattern, is a powerful independent predictor of late LV dilation and, most importantly, of cardiac death in patients with AMI and clearly indicate the need for evaluating and monitoring LV diastolic function in these patients. Large scale studies, utilizing simple and easy to measure Doppler indexes of LV filling are needed to assess the efficacy of medical therapy in patients with acute LV diastolic dysfunction during AMI.