Echocardiographic evaluation of lv diastolic function
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Echocardiographic Evaluation of LV Diastolic Function. Natalie Bello, M.D. October 14, 2009. Objectives. Defining Diastole Diastolic Function Measurements Diastolic Function Grades. Diastology:.

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Echocardiographic Evaluation of LV Diastolic Function

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Echocardiographic evaluation of lv diastolic function

Echocardiographic Evaluation of LV Diastolic Function

Natalie Bello, M.D.

October 14, 2009


Objectives

Objectives

  • Defining Diastole

  • Diastolic Function Measurements

  • Diastolic Function Grades


Diastology

Diastology:

The science and art of characterizing left ventricular relaxation, filling dynamics, and their integration into clinical practice.


What is diastole

What is Diastole?

Insert Otto Figure 7-1 +/- 7-2


Objectives1

Objectives

  • Defining Diastole

  • Diastolic Function Measurements

  • Diastolic Function Grades


Transmitral doppler inflow

Transmitral Doppler Inflow

http://www.echobasics.de/diastole-en.html


Echocardiographic evaluation of lv diastolic function

IVRT


Echocardiographic evaluation of lv diastolic function

Tissue Doppler Imaging (e’)

http://www.echobasics.de/diastole-en.html


Tissue doppler imaging e

Tissue Doppler Imaging (e’)

  • E/e’ ratio (combo of transmitral flow velocity and annular velocity) is best parameter for predicting mean LVEDP (<8 nl, >15 abnl); but cannot be used in isolation!


Echocardiographic evaluation of lv diastolic function

Pulmonary Venous Doppler Flow

http://www.echobasics.de/diastole-en.html


Mitral inflow propagation velocity vp

Mitral Inflow Propagation Velocity (Vp)

http://www.echobasics.de/diastole-en.html


Global strain rate srivr

Global Strain Rate (SRivr)

Wang et al Global Diastolic SR for LV Relaxation Circ. 2007; 115:1376-1383.


La volume

LA Volume

  • Barometer of the chronicity of diastolic dysfunction.

  • LA volume correlates with risk of cardiovascular events including MI, CVA, A fib and CHF.

  • More stable than LV filling pressures.

Douglas PS. The left atrium: a biomarker of chronic diastolic dysfunction and cardiovascular disease risk. JACC 2002;42:1206-7.


Objectives2

Objectives

  • Defining Diastole

  • Diastolic Function Measurements

  • Diastolic Function Grades


Echocardiographic evaluation of lv diastolic function

BIDMC Echo Lab

Decel Time 140-250ms

E/e’: <8 normal

E/e’>15 (LVEDP>18mmHg)


Approach to the patient

Approach to the Patient


Summary

Summary

  • Diastole is a complex, energy dependent process.

  • Echo indices of diastolic fn include:

    • Transmitral Doppler inflow

    • Tissue Doppler velocities

    • Pulmonary venous Doppler flow

    • Color M-mode propagation velocity

  • Diastolic dysfunction is a measurable, step-wise progression from normal to irreversible.


References

References

  • Otto CM. Textbook of clinical echocardiography, 4th Edition.

  • Douglas PS. The left atrium: a biomarker of chronic diastolic dysfunction and relation to cardiovascular risk burden. JACC 2002;40:1206-7.

  • http://www.echobasics.de/diastole-en.html

  • Lester SJ, Tajik AJ, Nishimura RA, et al. Unlocking the mysteries of diastolic function. JACC 2008;51:679-89.

  • Nagueh SF, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am S Echo 2009;22:107-33

  • Nishimura RA, Tajik AJ. Evaluation of diastolic filling of left ventricle in health and disease: Doppler echocardiography is the clinician’s Rosetta Stone. JACC 1997;30:8-18.

  • Ommen SR, Nishimura RA, Appleton CP, et al. Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: a comparative simultaneous Doppler-catheterization study. Circ. 2000;102:1788-94.

  • Wang J, Khoury DS, Thohan V, Torre-Amione G, Nagueh SF. Global diastolic strain rate for the assessment of left ventricular relaxation and filling pressures. Circ. 2007;115:1376-83.


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