The role of left ventricular (LV) diastolic function in health and disease is still incompletely understood and underappreciated by most primary care physicians and many cardiologists. This is not surprising because diastole is a complex phenomenon with many determinants that are difficult to individually study, and has several phases that encompass the relaxation and then filling of the ventricle.6 Appleton C.P., Galloway J.M., Gonzalez M.S. , e al. Estimation of left ventricular filling pressures using two-dimensional and Doppler echocardiography in adult patients with cardiac disease: Additional value of analyzing left atrial size, left atrial ejection fraction and the difference in duration of pulmonary venous and mitral flow velocity at atrial contraction J Am Coll Cardiol 1993 ; 22 : 1972-1982 [cross-ref]
Cliccare qui per andare alla sezione Riferimenti, 38 Grossman W. Diastolic function and heart failure: An overview Eur Heart J 1990 ; 11 : 2-7
Cliccare qui per andare alla sezione Riferimenti, 42 Hammermeister K.E., Warbasse J.R. The rate of change of left ventricular volume in man: II. Diastolic events in health and disease Circulation 1974 ; 49 : 739-747
Cliccare qui per andare alla sezione Riferimenti, 65 Little W.C., Downes T.R. Clinical evaluation of left ventricular diastolic performance Prog Cardiovasc Dis 1990 ; 32 : 273-290 [cross-ref]
Cliccare qui per andare alla sezione Riferimenti Physical examination, electrocardiogram (ECG), and chest radiographs are unreliable in making the diagnosis of LV diastolic dysfunction in most individuals, and invasive measurements of cardiac pressures, rates of LV relaxation, and LV compliance are costly, clinically impracticable as they carry increased risk, and require special catheters and software analysis programs.66 Little W.C., Downes T.R., Applegate R.J. Invasive evaluation of left ventricular diastolic performance Herz 1990 ; 15 : 362-376
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This situation changed with the development of echocardiography. Because of its noninvasive nature, large numbers of normal individuals and patients were studied and different LV filling patterns were described, first with M-mode echocardiography35 Gibson D.G., Brown D.J. Measurement of peak rates of left ventricular wall movement in man. Comparison of echocardiography with angiography Br Heart J 1975 ; 37 : 677-683 [cross-ref]
Cliccare qui per andare alla sezione Riferimenti, 36 Gibson D.G., Prewitt T.A., Brown D.J. Analysis of left ventricular wall movement during isovolumic relaxation and its relation to coronary artery disease British Heart Journal 1976 ; 38 : 1010-1019 [cross-ref]
Cliccare qui per andare alla sezione Riferimenti, 43 Hanrath P., Mathey D.G., Siegert R. , e al. Left ventricular relaxation and filling pattern in different forms of left ventricular hypertrophy: An echocardiographic study Am J Cardiol 1980 ; 45 : 15-23 [cross-ref]
Cliccare qui per andare alla sezione Riferimenti and later using pulsed-wave (PW) Doppler technique interrogating mitral inflow.45 Hatle L., Brubakk A., Tromsdal A. , e al. Noninvasive assessment of pressure drop in mitral stenosis by Doppler ultrasound Br Heart J 1978 ; 40 : 131-140 [cross-ref]
Cliccare qui per andare alla sezione Riferimenti, 46 Holen J., Aaslid R., Landmark K. , e al. Determination of pressure gradient in mitral stenosis with a noninvasive ultrasound Doppler technique Acta Med Scand 1976 ; 199 : 455-460
Cliccare qui per andare alla sezione Riferimenti, 53 Kitabatake A., Inoue M., Asao M. , e al. Transmitral blood flow reflecting diastolic behavior of the left ventricle in health and disease: A study by pulsed Doppler technique Jpn Circ J 1982 ; 46 : 92-102 [cross-ref]
Cliccare qui per andare alla sezione Riferimenti, 73 Miyatake K., Okamoto M., Kinoshita N. , e al. Augmentation of atrial contribution to left ventricular inflow with aging as assessed by intracardiac Doppler flowmetry Am J Cardiol 1984 ; 70 : 586-589 [cross-ref]
Cliccare qui per andare alla sezione Riferimenti, 110 Takenaka K., Dabestani A., Gardin J.M. , e al. Pulsed Doppler echocardiographic study of left ventricular filling in dilated cardiomyopathy Am J Cardiol 1986 ; 58 : 143-147 [cross-ref]
Cliccare qui per andare alla sezione Riferimenti, 112 Tanouchi J., Kitabatake A., Asao M. , e al. Role of left ventricular relaxation on transmitral flow dynamics during early diastole: pulsed Doppler flowmetry J Cardiogr 1983 ; 13 : 301-307
Cliccare qui per andare alla sezione Riferimenti Validation of these mitral filling patterns against radionuclide and angiographic techniques soon followed;96 Rokey R., Kuo L.C., Zoghbi W.A. , e al. Determination of parameters of left ventricular diastolic filling with pulsed Doppler echocardiography: Comparison with cineangiography Circulation 1985 ; 71 : 543-550 [cross-ref]
Cliccare qui per andare alla sezione Riferimenti, 104 Spirito P., Maron B.J., Bonow R.O. Noninvasive assessment of left ventricular diastolic function: Comparative analysis of Doppler echocardiographic and radionuclide angiographic techniques J Am Coll Cardiol 1986 ; 7 : 518-526 [cross-ref]
Cliccare qui per andare alla sezione Riferimenti however, enthusiasm for relating LV filling patterns to diastolic function was dampened by reports that the velocity and proportion of early and late diastolic filling and their peak velocities were affected by preload,106 Stoddard M.F., Pearson A.C., Kern M.J. , e al. Influence of alteration in preload on the pattern of left ventricular diastolic filling as assessed by Doppler echocardiography in humans Circulation 1989 ; 79 : 1226-1236 [cross-ref]
Cliccare qui per andare alla sezione Riferimenti, 106 Stoddard M.F., Pearson A.C., Kern M.J. , e al. Influence of alteration in preload on the pattern of left ventricular diastolic filling as assessed by Doppler echocardiography in humans Circulation 1989 ; 79 : 1226-1236 [cross-ref]
Cliccare qui per andare alla sezione Riferimenti afterload,77 Nishimura R.A., Abel M.D., Hatle L.K. , e al. Assessment of diastolic function of the heart: Background and current applications of Doppler echocardiography: Part II. Clinical studies Mayo Clin Proc 1989 ; 64 : 181-204
Cliccare qui per andare alla sezione Riferimenti and heart rate.4 Appleton C.P. Influence of incremental changes in heart rate on mitral flow velocity: Assessment in lightly sedated, conscious dogs J Am Coll Cardiol 1991 ; 17 : 227-227 [cross-ref]
Cliccare qui per andare alla sezione Riferimenti, 77 Nishimura R.A., Abel M.D., Hatle L.K. , e al. Assessment of diastolic function of the heart: Background and current applications of Doppler echocardiography: Part II. Clinical studies Mayo Clin Proc 1989 ; 64 : 181-204
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In 1988, hemodynamic pressure measurements were related to individual LV filling patterns, independent of disease state.9 Appleton C.P., Hatle L.K., Popp R.L. Relation of transmitral flow velocity patterns to left ventricular diastolic function: New insights from a combined hemodynamic and Doppler echocardiographic study J Am Coll Cardiol 1988 ; 12 : 426-440 [cross-ref]
Cliccare qui per andare alla sezione Riferimenti Three basic abnormal filling patterns were described and were soon found to have clinical significance and prognostic value regardless of cardiac disease type.7 Appleton C.P., Hatle L.K. The natural history of left ventricular filling abnormalities: Assessment by two-dimensional and Doppler echocardiography Echocardiography 1992 ; 9 : 437-457 [cross-ref]
Cliccare qui per andare alla sezione Riferimenti, 56 Klein A.L., Hatle L.K., Taliercio C.P. , e al. Comprehensive Doppler assessment of right ventricular diastolic function in cardiac amyloidosis J Am Coll Cardiol 1990 ; 15 : 99-108 [cross-ref]
Cliccare qui per andare alla sezione Riferimenti, 84 Oh J.K., Ding Z.P., Gersh B.J. , e al. Restrictive LV diastolic filling identifies patients with heart failure after acute myocardial infarction J Am Soc Echocardiogr 1992 ; 5 : 497-503
Cliccare qui per andare alla sezione Riferimenti, 90 Pinamonti B., Di Lenarda A., Sinagra G. , e al. Restrictive left ventricular filling pattern in dilated cardiomyopathy assessed by Doppler echocardiography: Clinical, echocardiographic and hemodynamic correlations and prognostic implications. Heart Muscle Disease Study Group J Am Coll Cardiol 1993 ; 22 : 808-815 [cross-ref]
Cliccare qui per andare alla sezione Riferimenti, 117 Vanoverschelde J.L., Raphael D.A., Robert A.R. , e al. Left ventricular filling in dilated cardiomyopathy: Relation to functional class and hemodynamics J Am Coll Cardiol 1990 ; 15 : 1288-1295 [cross-ref]
Cliccare qui per andare alla sezione Riferimenti, 124 Xie G.Y., Berk M.R., Smith M.D. , e al. Prognostic value of Doppler transmitral flow patterns in patients with congestive heart failure J Am Coll Cardiol 1994 ; 24 : 132-139 [cross-ref]
Cliccare qui per andare alla sezione Riferimenti The field of diastology using echo-Doppler evaluation was born20 DeMaria A.N., Blanchard D. 50th anniversary historical article: The hemodynamic basis of diastology J Am Coll Cardiol 1999 ; 34 : 1659-1662 [cross-ref]
Cliccare qui per andare alla sezione Riferimenti and steady progress continued. Today this LV diastolic evaluation includes interrogation of mitral and pulmonary venous flow velocities, the rate of mitral inflow velocity by color Doppler flow propagation, and the evaluation of mitral annular motion by tissue Doppler imaging (TDI). In addition, manipulation of preload and afterload assesses how sensitive abnormal LV filling patterns are to changes in loading conditions.21 Dumesnil J.G., Gaudreault G., Honos G.N. , e al. Use of Valsalva maneuver to unmask left ventricular diastolic function abnormalities by Doppler echocardiography in patients with coronary artery disease or systemic hypertension Am J Cardiol 1991 ; 68 : 515-519 [cross-ref]
Cliccare qui per andare alla sezione Riferimenti, 47 Hurrell D.G., Nishimura R.A., Ilstrup D.M. , e al. Utility of preload alteration in assessment of left ventricular filling pressure by Doppler echocardiography: A simultaneous catheterization and Doppler echocardiographic study J Am Coll Cardiol 1997 ; 30 : 459-467 [cross-ref]
Cliccare qui per andare alla sezione Riferimenti, 92 Pozzoli M., Traversi E., Cioffi G. , e al. Loading manipulations improve the prognostic value of Doppler evaluation of mitral flow in patients with chronic heart failure Circulation 1997 ; 27 : 423-429
Cliccare qui per andare alla sezione Riferimenti Although all echo-Doppler indices remain imperfect and much remains to be learned, the aggregate sum of this information remains our best and most practical way to assess LV diastolic function, and to objectively follow serial changes after medical intervention or with disease progression.
To begin to use echo-Doppler information for patient evaluation and management requires a basic understanding of cardiac physiology, particularly LV diastolic properties and LV filling patterns, and reproducible high-quality Doppler flow velocity recording.10 Appleton C.P., Jensen J.L., Hatle L.K. , e al. Doppler evaluation of left and right ventricular diastolic function: A technical guide for obtaining optimal flow velocity recordings J Am Soc Echocardiogr 1997 ; 10 : 271-292 [cross-ref]
Cliccare qui per andare alla sezione Riferimenti The routine performance of a diastolic function examination on every patient referred for echocardiography is recommended for acquiring experience to eliminate technical and interpretive pitfalls. This article explains a practical way for approaching the echo-Doppler analysis of LV diastolic function, and how the information obtained may be used clinically to aid patient diagnosis and therapy.
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© 2000
W. B. Saunders Company. Pubblicato da Elsevier Masson SAS. Tutti i diritti riservati.© 1993
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