Elsevier

American Heart Journal

Volume 160, Issue 3, September 2010, Pages 394-404
American Heart Journal

Progress in Cardiology
Diastolic dysfunction: Improved understanding using emerging imaging techniques

https://doi.org/10.1016/j.ahj.2010.06.040Get rights and content

Diastolic heart failure is increasing in prevalence. Although the pathophysiology is incompletely understood and current therapeutic strategies are limited, identification of diastolic dysfunction is important. We review the role of contemporary techniques with echocardiography and cardiac magnetic resonance imaging (CMRI) in the assessment of diastolic dysfunction. Cardiac catheterization is the criterion standard for demonstrating impaired relaxation and filling by making direct measurements; however, echocardiography has replaced it as the most clinically used tool. By evaluating mitral inflow pulsed-wave Doppler with and without the Valsalva maneuver, isovolumetric relaxation time, pulmonary venous flow Doppler, color M-mode velocity propagation, tissue Doppler imaging, and speckle tracking, echocardiography is considered an accurate method for diagnosis and grading diastolic dysfunction. Evaluation of diastolic function can also be performed by CMRI. Mitral valve inflow velocities, early deceleration time, and pulmonary vein flow velocities are diastolic parameters that can be measured by phase-contrast CMRI. Cardiac magnetic resonance imaging steady-state gradient echo can evaluate functional dimensions for time-volume curves; and myocardial tagging can assess ventricular diastolic “untwisting,” which may be important for improved pathophysiologic understanding. Studies have compared echocardiography and CMRI for diagnosing diastolic dysfunction in small patient groups with similar results. Cardiac magnetic resonance imaging can now provide clinically relevant data regarding the underlying cause of diastolic dysfunction and offers promise to gain mechanistic insights for therapeutic strategy development and clinical trial planning.

Section snippets

Diagnosis by echocardiography

Measurement of LV pressure decline over time by cardiac catheterization is a useful parameter of impaired diastolic relaxation, but this has largely been replaced by echocardiography to assess diastolic function.7 Initial techniques, such as mitral valve inflow pulsed-wave Doppler, are dependent on loading conditions, systolic function, and heart rate; but recent methods are load independent and have improved assessment of diastolic dysfunction.8

Conclusion

The assessment of diastolic function is now essential on routine testing for HF. The noninvasive nature of echocardiography has allowed an increase in diagnosis and awareness of diastolic dysfunction, whereas or the unique features of CMRI allow for the detailed evaluation of diastolic dysfunction. Both modalities offer insights into the mechanism of diastolic dysfunction in HF with normal LVEF. The increased and rising prevalence of HF with normal LVEF, along with the absence of effective

Disclosure

No extramural funding was used to support this manuscript. The authors are solely responsible for the drafting and editing of the paper and its final contents.

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