New approaches to the Doppler echocardiographic assessment of diastolic function: from research laboratory to clinical practice

Over the past decade, Doppler echocardiography has become a well-establishe d tool for the diagnosis of left ventricular diastolic dysfunction. Unfortu nately, in many clinical situations traditional Doppler indices of transmit ral and pulmonary venous flow are inconclusive, primarily due to their depe ndence on left atrial pressure. Recently, new Doppler indices that are much less dependent on preload have been developed, based on intraventricular f low propagation and intrinsic myocardial velocity. These methodologies prov ide direct assessment of ventricular relaxation and the small: intraventric ular pressure gradients essential to efficient filling of the ventricle. We review in this article the theoretical and experiment background of these new echo techniques as well as how they can be implemented in routine clini cal practice. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.