Echocardiographic Evaluation of LV Diastolic Function

Natalie Bello, M.D.

October 14, 2009

Objectives

• Defining Diastole

• Diastolic Function Measurements

• Diastolic Function Grades

Diastology:

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

What is Diastole?

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

Objectives

• Defining Diastole

• Diastolic Function Measurements

• Diastolic Function Grades

Transmitral Doppler Inflow

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

IVRT

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!

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

Pulmonary Venous Doppler Flow

Mitral Inflow Propagation Velocity (Vp)

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

Global Strain Rate (SRivr)

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

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.

Objectives

• Defining Diastole

• Diastolic Function Measurements

• Diastolic Function Grades

diastole_en.exe

BIDMC Echo Lab

Decel Time 140-250msE/e’: <8 normalE/e’>15 (LVEDP>18mmHg)

Approach to the Patient

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• 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.