The study of left ventricular diastolic function by Doppler echocardiography: the essential for the clinician

Abstract

An abnormal diastolic function of left ventricle represents the main pathophysiological mechanism responsible for different clinical states such as restrictive cardiomyopathy, infiltrative myocardial disease and, specially, diastolic heart failure (also called heart failure with preserved systolic function), which is present in a large number of patients with a clinical picture of pulmonary congestion.Although the invasive approach, through cardiac catheterization allowing the direct measurement of left ventricular filling pressure, myocardial relaxation and compliance, is considered the gold standard for the identification of diastolic dysfunction, several noninvasive methods have been proposed for the study of left ventricular diastolic function.Doppler echocardiography represents an excellent noninvasive technique to fully characterize the diastolic function in health and disease.

Keywords: Diastolic function; Doppler echocardiography; Heart failure.

Fig. 1

- Schematic representation of the cardiac cycle. The different phases of diastole are indicated. See the text for details.

Fig. 2

- Pulsed Doppler transmitral flow: a. the sample volume of pulsed Doppler is positioned at the tips of the mitral leaflets to record the tranmitral flow; b. example of pulsed Doppler flow at the mitral flow: the peak velocity in early dialstole and atrial systole are shown. The dotted line on descent of early filling wave indicates how to measure the deceleration time. See the text for details.

Fig. 3

- Isovolumetric relaxation time (IVRT). The sample volume is positioned between the left ventricular outflow tract and the anterior mitral leaflet; the time interval between the end of aortic flow and the beginning of mitral flow (dotted lines) represents the IVRT. See the text for details.

Fig. 4

- Pulsed Doppler flow of pulmonary vein: a. the sample volume of pulsed Doppler is positioned in the upper pulmonary vein (usually the right), just before its entry in the left atrium; b. anterograde flow in systole and early diastole and retrograde flow during atrial contraction are shown. See the text for details.

Fig. 5

- Tissue pulsed Doppler of the mitral annulus: a. the sample volume is positioned at the lateral segment of mitral annulus; b. peak tissue Doppler velocity in early diastole and atrial contraction are shown. See the text for details.

Fig. 6

- Correlation between mitral E/Em ratio on tissue Doppler of mitral annulus and left ventricular filling pressure (modified from Nagueh et al (8)). See the text for details.

Fig. 7

- Different Doppler patterns of diastolic dysfunction: modified from Zile et al (21). See the text for details.

Fig. 8

- The effect of valsalva maneuver on pulsed Doppler of transmitral flow in order to differentiate between the true normal and pseudonormal left ventricular filling pattern. See the text for details.