Review article
Diastolic Function: A Sonographer’s Approach to the Essential Echocardiographic Measurements of Left Ventricular Diastolic Function

https://doi.org/10.1016/j.echo.2006.08.005Get rights and content

Noninvasive assessment of left ventricular filling pressures by echocardiography has been validated by invasive hemodynamic studies and correlated with clinical findings. A comprehensive echocardiographic examination based on the referral diagnosis and patient symptomatology routinely includes efforts to measure specific parameters of left ventricular diastolic function. We provide a step-by-step approach to goal-directed echocardiographic assessment of diastolic function.

Section snippets

Imaging Views and Techniques

The echocardiographic acquisition of diastolic parameters is best accomplished when integrated within a standardized examination. Current state-of-the-art assessment of LV diastolic function is acquired from the apical tomographic imaging planes. Specifically, the sonographer presents apical 4-chamber, 2-chamber, and apical long-axis views that include the LV and the left atrium (LA). Every effort should be made to limit foreshortened imaging of the chambers to provide the reviewer with a

Assessment of LA Volume

Increased indexed LA volumes, obtained at the end of LV systole, have been shown to have clinically significant correlation with chronically elevated LV filling pressures.11, 12 Apical 4- and 2-chamber views allow acquisition of the required measurements needed to calculate LA volumes either by Simpson vs rule or the area-length method.10, 13, 14 Whereas LA volume determination by Simpson vs rule is accomplished by using the onboard calculation software of the ultrasound machine, the

Discussion

Our step-by-step approach and image-optimizing suggestions may be used to facilitate the essential echocardiographic diastolic assessment. A list of the measurements and their corresponding views and related imaging suggestions are provided in Table 3, Table 4. The comprehensive echocardiogram should include an assessment of diastolic function. An acquisition of diastolic filling parameters, readily obtainable in most patients, provides the reviewing echocardiographer with the necessary data to

References (33)

Cited by (50)

  • Diastolic dysfunction in hypertension

    2017, Hipertension y Riesgo Vascular
    Citation Excerpt :

    The measurement of LV diastolic function and filling pressures is critical to distinguish between LV DD, or HFpEF, pulmonary diseases, identification of other cardiac disease, defining treatments and prognostic determination. The echocardiographic determination of the LV filling pressures, using 2D and Doppler analysis, and the systematization of the procedures made this as the test of choice in these patients.65–67 The approach to assess LV diastolic function aims to quantify the degree of LV final pressure (LVFP) rather than classify, by Doppler, diastolic patterns.

  • A pilot study of patients with clinically severe obesity undergoing laparoscopic surgery: Evidence for impaired cardiac performance

    2011, Journal of Cardiothoracic and Vascular Anesthesia
    Citation Excerpt :

    PW DTI offers several advantages over the traditional methods in diagnosing DD. These include greater sensitivity for detecting LV DD, relative preload independence, and less operator dependence.28-32 The presence of intraoperative DD and, more specifically, the development of new-onset DD with pneumoperitoneum, may have a potential prognostic value for the long-term perioperative outcome of these patients.

  • Evaluation of ventricular filling pressures and ventricular function by doppler echocardiography in patients with functional single ventricle: Correlation with simultaneous cardiac catheterization

    2011, Journal of the American Society of Echocardiography
    Citation Excerpt :

    However, the confidence intervals for both curves were wide. Echocardiographically obtained pulsed-wave and tissue Doppler has emerged as a very practical tool in the noninvasive estimation of ventricular filling pressures and diastolic function in both adult and pediatric practices.10,12,13 In adults with biventricular physiology, an E/E′ ratio < 8 identified patients with normal filling pressures, and a ratio > 15 predicted elevated left ventricular filling pressures (>12 mm Hg).9,11

  • Perioperative assessment of diastolic dysfunction

    2011, Anesthesia and Analgesia
    Citation Excerpt :

    In the following section, the specific steps of obtaining satisfactory Doppler profiles for diastolic function evaluation using TEE are discussed. Echocardiographic evaluation of diastolic function is best accomplished when it is incorporated within a standardized echocardiographic examination, which should also include a comprehensive evaluation of LV systolic function.56,61 Before starting the Doppler examination, it is essential to ensure the most optimal parallel Doppler alignment during interrogation to minimize the degree of underestimation of peak velocities and gradients.

View all citing articles on Scopus
View full text