Ventricular Diastolic Filling and Function

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Ventricular Diastolic Filling and Function

Basic Principles

Step-By-Step Approach

Step 1: Measure Left Ventricular Inflow Velocities

Key Points

Step 2: Record Left Atrial Inflow

Key Points

Step 3: Record Tissue Doppler at the Mitral Annulus

Step 4: Measure the Isovolumic Relaxation Time

Step 5: Consider Other Useful Measurements

  1. ▪ The diastolic slope of the apical color M-mode recording of LV inflow (the propagation velocity) reflects the rate of LV diastolic relaxation (Fig. 7.11).
  2. ▪ The rate of decline in velocity of the mitral regurgitant jet at end-systole reflects the early diastolic rate of decline in LV pressure (Fig. 7.12).
Key Points

Step 6: Integrate the Data (Table 7.1)

  1. ▪ Measurement of LA size (diameter and/or indexed volume) is useful in the assessment of diastolic function. Chronically elevated LV filling pressure leads to increased LA chamber size.
  2. ▪ Based on integration of data from LA size, LV filling velocities, LA filling velocities, tissue Doppler, and IVRT, diastolic dysfunction can be detected and graded (Fig. 7.13).
  3. ▪ The clinical interpretation of the data also takes several other factors into consideration, including mitral regurgitation, LV systolic function, LV wall thickness, and clinical signs and symptoms.

Normal Diastolic Function (Fig. 7.14)

Characteristic Features

TABLE 7.1

Classification of Diastolic Dysfunction
Normal Mild (Grade I) Moderate (Grade II) Severe (Grade III)
Pathophysiology
↓ Relaxation
Normal LV EDP
↓ Relaxation and ↑ LV EDP ↓ Compliance and ↑ ↑ LV EDP
E/A ratio ≥0.8 <0.8 >0.8 to <2.0 § ≥2.0
Valsalva ΔE/A <0.5 ≥0.5 ≥0.5
DT (ms) 150-200 >200 150-200 <150
E′ velocity (cm/s) ≥10 <8 <8 <5
E/E′ ratio ≤10 ≤10 10-14 >14
IVRT (ms) 50-100 ≥100 60-100 ≤60
PV S/D ≅1 S > D S < D S << D
PVa (m/s) <0.35 <0.35 ≥0.35 ≥0.35
a durA dur (ms) <20 <20 ≥30 ≥30
LA volume index <34 mL/m2 Mildly enlarged Moderately enlarged Severely enlarged

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Apr 23, 2020 | Posted by in CARDIOLOGY | Comments Off on Ventricular Diastolic Filling and Function

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