THE NONINVASIVE ASSESSMENT OF LEFT-VENTRICULAR DIASTOLIC FUNCTION WITH 2-DIMENSIONAL AND DOPPLER-ECHOCARDIOGRAPHY

Left ventricular diastolic filling can be determined reliably by Doppl er-derived mitral and pulmonary venous flow velocities. Diastolic fill ing abnormalities ore broadly classified at their extremes to impaired relaxation and restrictive physiology with many patterns in between. An impaired relaxation pattern identifies patients with early stages o f heart disease, and appropriate therapy may avert progression and fun ctional disability. Pseudonormalization is a transitional phase betwee n abnormal relaxation and restrictive physiology and signifies increas ed filling pressure and decreased compliance. In this phase, reducing preload, optimizing afterload, and treating the underlying disease are clinically helpful. A restrictive physiology pattern identifies advan ced, usually symptomatic disease with a poor prognosis. Therapeutic in tervention is directed toward normalizing loading conditions and impro ving the restrictive filling pattern, although this may not be feasibl e in certain heart diseases. Finally, many patients have left ventricu lar filling patterns that appear indeterminate or mixed. In these case s, clinical information, left atrial and left ventricular size, pulmon ary venous flow velocity, alteration of preload help assess diastolic function and estimate diastolic filling pressures.