Established and novel clinical applications of diastolic function assessment by echocardiography.
TLDR
A cardiac cycle consists of systolic (contraction) and diastolic (relaxation and filling) phases that are linked closely together for optimal function of the heart.Abstract:
A cardiac cycle consists of systolic (contraction) and diastolic (relaxation and filling) phases that are linked closely together for optimal function of the heart. Normal diastolic function allows adequate filling of the heart without an excessive increase in diastolic filling pressure both in the resting state and with stress or exertion.1 The diastolic phase is remarkably well designed to ensure that the ventricle is optimally filled for a given clinical condition.2 Basically, at the end of systole, left ventricular (LV) relaxation begins as an initial diastolic process, and LV pressure falls rapidly as the LV expands. This relaxation phase is accompanied by active movement of the mitral annulus away from the apex. The velocity of LV dilatation and mitral annular movement during early diastole correlates well with how fast the LV fills and relaxes, respectively.3,4 Myocardial relaxation continues during early diastole to reach the minimal LV diastolic pressure, which helps with “sucking” or “pulling” the blood actively into the LV (Figure 1, online-only Data Supplement Video 1A). The minimal LV diastolic pressure or completion of relaxation normally occurs by 3.5 times the value of tau—the time constant of relaxation (normal <45 ms)—after the mitral opening.5 LV pressure then rises to be equilibrated with left atrial (LA) pressure, at which time the early diastolic filling decelerates to close the mitral valve until the time of atrial contraction when LA pressure increases to initiate the late filling to complete diastole (Figure 1, online-only Data Supplement Video 1B).
Figure 1.
Top, Schematic diagram of mitral inflow and mitral medial annulus velocities from normal to progressive stages of diastolic dysfunction. Mitral inflow E is sensitive to preload, becoming higher with shorter deceleration time (time from the peak to the baseline) as diastolic function becomes worse with increasing filling …read more
Citations
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Estimating Left Ventricular Filling Pressure by Echocardiography
O S Andersen,Otto A. Smiseth,Hisham Dokainish,Muaz M. Abudiab,Robert C. Schutt,Arnav Kumar,Kimi Sato,Serge C. Harb,Einar Gude,Espen W. Remme,Arne K. Andreassen,Jong-Won Ha,Jiaqiong Xu,Allan L. Klein,Sherif F. Nagueh +14 more
TL;DR: Echocardiographic assessment of LV filling pressure is feasible and accurate and when combined with clinical data, it leads to a more accurate diagnosis, regardless of LVEF.
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Clinical Spectrum, Frequency, and Significance of Myocardial Dysfunction in Severe Sepsis and Septic Shock
Juan N. Pulido,Bekele Afessa,Mitsuru Masaki,Mitsuru Masaki,Toshinori Yuasa,Toshinori Yuasa,Shane M. Gillespie,Vitaly Herasevich,Daniel R. Brown,Jae K. Oh +9 more
TL;DR: Myocardial dysfunction is frequent in patients with severe sepsis or septic shock and has a wide spectrum including LV diastolic, LV systolic, and RV dysfunction types, which is not associated with increased 30-day or 1-year mortality.
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Pathophysiology of sepsis-induced cardiomyopathy.
TL;DR: In this article, the authors explore the definition, epidemiology, diagnosis and pathophysiology of septic cardiomyopathy, with an emphasis on how best to interpret this condition in the clinical context.
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Expert consensus document: Echocardiography and lung ultrasonography for the assessment and management of acute heart failure
Susanna Price,Elke Platz,Louise Cullen,Guido Tavazzi,Michael Christ,Martin R. Cowie,Alan S. Maisel,Josep Masip,Òscar Miró,John J.V. McMurray,W. Frank Peacock,F. Javier Martín-Sánchez,Salvatore Di Somma,Héctor Bueno,Uwe Zeymer,Christian Mueller +15 more
TL;DR: This Consensus Statement, prepared by the Acute Heart Failure Study Group of the ESC Acute Cardiovascular Care Association, reviews the existing and potential roles of echocardiography and lung ultrasonography in the assessment and management of patients with acute heart failure, highlighting the differences from established practice where relevant.
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Tissue Doppler Imaging in Echocardiography: Value and Limitations
TL;DR: Tissue Doppler imaging (TDI) is a useful echocardiographic technique to evaluate global and regional myocardial systolic as well as diastolic function and it is underutilised in routine clinical practice.
References
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Journal ArticleDOI
Recommendations for the evaluation of left ventricular diastolic function by echocardiography
Sherif F. Nagueh,Christopher P. Appleton,Thierry C. Gillebert,Paolo Marino,Jae K. Oh,Otto A. Smiseth,Alan D. Waggoner,Frank A. Flachskampf,Patricia A. Pellikka,Arturo Evangelista +9 more
TL;DR: Recommendations for the evaluation of left ventricular diastolic function by echocardiography are made and further research is needed to determine the best method for this evaluation.
Journal ArticleDOI
Recommendations for the evaluation of left ventricular diastolic function by echocardiography
Sherif F. Nagueh,Christopher P. Appleton,Thierry C. Gillebert,Paolo Marino,Jae K. Oh,Otto A. Smiseth,Alan D. Waggoner,Frank A. Flachskampf,Patricia A. Pellikka,Arturo Evangelisa +9 more
TL;DR: The assessment of left ventricular (LV) diastolic function and filling pressures is of paramount clinical importance to distinguish this syndrome from other diseases such as pulmonary disease resulting in dyspnea, to assess prognosis, and to identify underlying cardiac disease and its best treatment.
Journal ArticleDOI
Doppler Tissue Imaging: A Noninvasive Technique for Evaluation of Left Ventricular Relaxation and Estimation of Filling Pressures
Sherif F. Nagueh,Katherine J. Middleton,Helen A. Kopelen,William A. Zoghbi,Miguel A. Quinones +4 more
TL;DR: Mitral E velocity, corrected for the influence of relaxation (i.e., the E/Ea ratio), relates well to mean PCWP and may be used to estimate LV filling pressures.
Journal ArticleDOI
Clinical Utility of Doppler Echocardiography and Tissue Doppler Imaging in the Estimation of Left Ventricular Filling Pressures A Comparative Simultaneous Doppler-Catheterization Study
Steve R. Ommen,Rick A. Nishimura,Christopher P. Appleton,Fletcher A. Miller,J K Oh,Margaret M. Redfield,Abdul J. Tajik +6 more
TL;DR: The combination of tissue Doppler imaging of the mitral annulus and mitral inflow velocity curves provides better estimates of LV filling pressures than other methods (pulmonary vein, preload reduction), however, accurate prediction of filling pressures for an individual patient requires a stepwise approach incorporating all available data.
Journal ArticleDOI
Assessment of mitral annulus velocity by Doppler tissue imaging in the evaluation of left ventricular diastolic function.
Dae-Won Sohn,In-Ho Chai,Dong-Jun Lee,Hee Chan Kim,Hyo-Soo Kim,Byung Hee Oh,Myoung-Mook Lee,Young-Bae Park,Yun-Shik Choi,Jung-Don Seo,Young-Woo Lee +10 more
TL;DR: In this article, the authors assessed the clinical utility of mitral annulus velocity in the evaluation of left ventricular diastolic function and found that mitral velocity determined by DTI is a relatively preload-independent variable in evaluating diASTolic function.
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