EVALUATION OF LEFT-VENTRICULAR DIASTOLIC FUNCTION FROM THE PATTERN OFLEFT-VENTRICULAR FILLING

The pattern of left ventricular (LV) filling can be determined by Dopp ler echocardiography. Normally most LV filling occurs early in diastol e, with some additional filling occurring during atrial systole, late in diastole. In the absence of mitral stenosis, three patterns of LV f illing indicate progressively greater diastolic dysfunction: (1) Reduc ed early diastolic filling with a compensatory increase in importance of atrial filling, termed a pattern of ''impaired relaxation,'' (2) '' pseudo-normalization'' with most filling early in diastole but with ra pid deceleration of mitral flow; and (3) ''restricted filling'' with a lmost all filling of the LV occurring very early in diastole in associ ation with very rapid deceleration of mitral flow. A large, prolonged atrial regurgitant flow in the pulmonary veins also indicates impaired diastolic performance. The time for early filling deceleration is pre dominantly determined by LV stiffness: the shorter the deceleration ti me, the stiffer the LV. Patients with short deceleration time have a p oor prognosis.