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Echocardiographic Evaluation of LV Diastolic Function

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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  1. Echocardiographic Evaluation of LV Diastolic Function Natalie Bello, M.D. October 14, 2009

  2. Objectives • Defining Diastole • Diastolic Function Measurements • Diastolic Function Grades

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

  4. What is Diastole? Insert Otto Figure 7-1 +/- 7-2

  5. Objectives • Defining Diastole • Diastolic Function Measurements • Diastolic Function Grades

  6. Transmitral Doppler Inflow http://www.echobasics.de/diastole-en.html

  7. IVRT

  8. Tissue Doppler Imaging (e’) http://www.echobasics.de/diastole-en.html

  9. 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!

  10. Pulmonary Venous Doppler Flow http://www.echobasics.de/diastole-en.html

  11. Mitral Inflow Propagation Velocity (Vp) http://www.echobasics.de/diastole-en.html

  12. Global Strain Rate (SRivr) Wang et al Global Diastolic SR for LV Relaxation Circ. 2007; 115:1376-1383.

  13. 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.

  14. Objectives • Defining Diastole • Diastolic Function Measurements • Diastolic Function Grades

  15. BIDMC Echo Lab Decel Time 140-250ms E/e’: <8 normal E/e’>15 (LVEDP>18mmHg)

  16. Approach to the Patient

  17. 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.

  18. 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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