Role of transesophageal echocardiography in assessing diastolic dysfunction in a large clinical practice: A 9-year experience

Background Two-dimensional transthoracic echocardiography with respiratory monitoring has been used to characterize diseases that impair diastolic fun ction. Transesophageal echocardiography (TEE) has emerged as a complementar y technique to evaluate patients with these diseases. The purpose of this s tudy was to evaluate in a large clinical practice the utility of TEE with r espiratory monitoring for classification of patients with diastolic dysfunc tion. Methods Over a 9-year period TEE was used to examine 192 patients referred to an echocardiography laboratory for additional evaluation of abnormal dia stolic function. We performed pulsed-wave Doppler TEE of the left ventricul ar inflow and pulmonary veins and respiratory monitoring to categorize pati ents as showing restrictive physiologic Features, constriction with or with out effusion, mixed constriction and restriction, abnormal relaxation, pseu donormalization, large pericardial effusion or tamponade, or normal diastol ic Function. Results Patients with diastolic dysfunction underwent 3% of the total numbe r of transesophageal studies conducted during the study period. Among the 1 92 patients referred For TEE, abnormal diastolic function was found in 181 (94%); 11 (6%) had normal diastolic function. Seventy-one (39%) of the 181 patients had restrictive physiologic features. Constrictive pericarditis wa s found in 54 (30%) of the patients and was confirmed for all 31 patients w ho underwent pericardiectomy. Mixed constriction and restriction was presen t in 21 (12%) of the patients. The other 35 patients (19%) had abnormal rel axation, pseudonormalization, or large pericardial effusion or tamponade. T he cause of diastolic dysfunction was idiopathic For 32% of the patients, p revious cardiac operation for 26%, cardiac amyloidosis for 23%, radiation t herapy for 11%, and hypertension or advanced ischemic heart disease for 8%, Conclusion Two-dimensional and Doppler TEE with respiratory monitoring is u seful in categorizing patients with impaired diastolic function, primarily into those with restrictive physiologic Features or constrictive pericardit is.