Evaluation of Left Ventricular Diastolic Function by Echocardiography

Abstract

Despite the knowledge that the heart spends almost two-thirds of its time in diastole (relaxing and filling), its contractile activity was for a long time considered the core of its mechanical function and over which major concerns had been focused. It was after the 1980s that the scientific community began to realize the clinical significance of diastolic dysfunction among patients with signs and symptoms of heart failure (HF) but in whom ejection fraction was rather preserved. The recognition of the latter condition as “heart failure with preserved ejection fraction” (HF-PEF) impelled major efforts in order to identify the pathophysiological mechanisms underlying this emerging concept. The impact of diastolic dysfunction on cardiac morbidity and mortality is becoming increasingly understood. 

The hallmark of diastolic dysfunction is the impaired capacity to fill or maintain stroke volume without a compensatoy increase in filling pressures. Historically, invasive hemodynamics have provided useful information with respect to diastolic filling pressures, e.g., left atrial (LA) pressure and left ventricular (LV) end-diastolic pressure; left ventricular relaxation (time constant of relaxation-dP/dt) and operant chamber stiffness (pressure-volume loops, diastolic pressure contour). However, advances in echocardiographic assessment of LV diastolic function can lead to the replacement of invasive hemodynamics in the vast majority of patients. In the crucial question “can echocardiography accurately measure diastolic function?”, there are reasoned arguments on either side of the debate. Undoubtedly echocardiography has played a central role in the evaluation of LV diastolic function over the past two decades... (excerpt)