ECHO-DOPPLER ASSESSMENT OF LEFT-VENTRICULAR DIASTOLIC FUNCTION

In recent years it has been observed that the left ventricular (LV) di astolic dysfunction may be critical in determining exercise performanc e and the clinical picture of congestive heart failure. The echo-Doppl er technique has emerged as the more feasible and accurate noninvasive method for the bedside assessment of LV diastolic function. In additi on to the M-mode and 2D-echo information the Doppler recording of tran smitral (TM) and pulmonary venous (PV) flows allows a quite accurate e valuation of LV diastolic properties, filling pressures, and left atri al (LA) function. In particular: (1) an elevated LV end-diastolic pres sure is indicated by a higher than normal atrial reversal (AR) peak ve locity on PV flow tracing and/or by a duration of AR wave longer than mitral A wave, (2) an elevated mean LA pressure is characterized by a tall and narrow E wave on TM flow associated with a reduction of systo lic wave on PV flow, (3) an altered LV compliance shows restrictive ph ysiology, and (4) a depressed LA function is characterized by the asso ciation of small mitral A and AR waves on TM and PV flows, respectivel y. On the basis of these criteria several patterns of LV filling due t o different pathophysiologic conditions may be identified. Further ref inements in the assessment of LV diastolic function may be obtained by the study of early filling with intraventricular flow propagation by M-mode color Doppler and the measurement of the mitral A wave transit time from the LV inflow to outflow tract.