Left atrioventricular remodeling in the assessment of the left ventricle diastolic function in patients with heart failure: a review of the currently studied echocardiographic variables

Abstract

Multiparametric echocardiographic imaging of the failing heart is now increasingly used and useful in decision making in heart failure. The reasons for this, relies on the need of different strategies of handling these patients, as differentiation of systolic or diastolic dysfunction, as well as on the gamma of approaches available, such as percutaneous and surgical revascularization, devices implantations, and valvular regurgitations and stenosis corrections. Congestive heart failure in patients with normal left ventricular diameters or preserved left ventricular ejection fraction had been pointed out recently as present in a proportion so high as 40 to 50 percent of cases of heart failure, mainly due to the epidemics in well developed countries, as is the problem of not well controlled metabolic states (such as obesity and diabetes), but also due to the real word in developing countries, as is the case of hypertension epidemics and its lack of adequate control. As a matter of public utility, the guidelines in the diagnosis and treatment of such patients will have to be cheap, available, easily reproducible, and ideally will furnish answers for the clinician questions not in a binary "black or white" manner, but with graduations, so if possible it has to be quantitative. The present paper aim to focus on the current clinical applications of tissue Doppler and of left atrial function and remodeling, and its pathophysiologic relationship with the left ventricle, as will be cleared in the documented review of echocardiography that follows, considering that the need of universal data on the syndrome of the failing heart does not mean, unfortunately, that all patients and clinicians in developing countries have at their own health facilities the same imaging tools, since they are, as a general rule, expensive.

Figure 1

LV diastolic indices measured by transmitral Doppler. E: LV early filling flow velocity; A: late filling flow velocity; EDT: E-wave deceleration time; IVRT: LV isovolumic myocardial relaxation time.

Figure 2

LV diastolic pattern by tissue Doppler. S': LV systolic myocardial displacement velocity; E': LV early diastolic displacement velocity; A: LV late diastolic displacement velocity.

Figure 3

LV diastolic patterns measured by transmitral Doppler of the pulmonary flow and tissue Doppler. E/A ratio between the LV early filling flow E velocity and late flow A measured by transmitral Doppler EDT: E-wave deceleration time; S: pulmonary flow systolic velocity peak; D: pulmonary flow diastolic velocity peak; RA: retrograde atrial velocity peak; RA-dur: retrograde atrial flow duration; ms: milliseconds; E/E: ratio between the early filling flow E velocity measured by transmitral Doppler and the LV early diastolic myocardial displacement E' velocity measured by tissue Doppler.

Figure 4

TMD and TPD indices in basal condition and preload increase.

Figure 5

Left ventricle diastolic analysis in CF patients.