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Echocardiographic Assessment of Diastolic Function
Transcript of Echocardiographic Assessment of Diastolic Function
Tissue Doppler Imaging
Pulmonary Venous Return
Taken in the apical 4 chamber view
3 main measurements of interest:
- S: Systolic measurement that reflects changes in LV pressures and stroke volume
- D: Diastolic measurement that reflects changes in LV filling and compliance
- Ar: Reversal of flow due to atrial systole.
Echocardiographic Evaluation of Diastolic Function
What Does the Evaluation of Diastolic Function Tell Us??
Diastolic function is a broad term used to describe the multiple processes that occur during the diastolic phase of the cardiac cycle which affect the efficiency with which the left ventricle fills. These processes are directly related to myocardial relaxation and tone.
Severity of decreased LV relaxation
Severity of valvular obstruction
Effects of myocardial disease (Sarcoidosis, Amyloidosis)
Functionality of the LA
Indicates possible issues elsewhere
Evaluation of diastolic function gives valuable information that is directly related to numerous processes of the heart. These processes are important to consider when making a diagnosis because while normal diastolic function allows adequate filling of the heart without an increase in diastolic pressures, abnormal diastolic function can lead to or indicate a wide variety of both intra and extra cardiac issues.
What is Diastolic Function
Why do we care?
DISCLAIMER: It said RCIS, not RCS. Any errors contained in this presentation can be attributed entirely to my lack of registry and poor "Google"ing skills.
Traditional echocardiographic assessment of LV diastolic function relied on Doppler patterns of mitral inflow. Reflecting the pressure gradient between the left atrium and LV, transmitral velocities are directly related to left atrial pressure (preload) and ventricular relaxation. Because mitral inflow patterns are highly sensitive to preload and can change dramatically as diastolic dysfunction progresses, the use of mitral valve inflow patterns to assess diastolic function is limited.
TDI assessment of diastolic function is less load dependent than that provided by standard Doppler techniques (PW). Ea reflects the velocity of early myocardial relaxation as the mitral annulus ascends during early rapid LV filling. Peak velocity can be measured from any aspect of the mitral annulus from the apical views, with the lateral annulus most commonly used. Because of differences in myocardial fiber orientation, septal Ea velocities are slightly lower than lateral Ea velocities.
- E/A ratio is the primary measurement used here.
- Shows normal, impaired LV relaxation, pseudonormal LV filling, and restrictive LV filling.
- The most abnormal diastolic physiology and LV filling pattern variants are frequently seen in elderly patients with severe and long-standing hypertension or patients with hypertrophic cardiomyopathy.
- The mitral E-wave velocity primarily reflects the LA-LV pressure gradient during early diastole and is therefore affected by preload and alterations in LV relaxation.
- The mitral A-wave velocity reflects the LA-LV pressure gradient during late diastole, which is affected by LV compliance and LA contractile function.
- Alterations in LV end-systolic and/or end-diastolic volumes, LV elastic recoil, and/or LV diastolic pressures directly affect the mitral inflow velocities (ie, E wave) and time intervals