DOPPLER EVALUATION OF LEFT AND RIGHT-VENTRICULAR DIASTOLIC FUNCTION -A TECHNICAL GUIDE FOR OBTAINING OPTIMAL FLOW VELOCITY RECORDINGS

Doppler mitral flow velocities and related variables are used to asses s left (LV) and right ventricular filling and, indirectly, ventricular diastolic function. Three abnormal ventricular filling patterns (impa ired relaxation and pseudonormal and restrictive physiology) are recog nized in patients with various heart diseases and have been related to alterations in LV diastolic properties and filling pressures. More re cently, these variables have been used to assess the hemodynamic effec ts of drug therapy or heart surgery and prognosis in patients with res trictive and dilated cardiomyopathies. Despite these encouraging resul ts, widespread clinical use of these Doppler techniques has been hampe red by difficulties in obtaining accurate and reproducible measurement s from Doppler now velocity recordings. This is due, in part, to an un derappreciation of factors such as cardiac filling mechanics, Doppler examination principles, and ultrasound machine settings, which can mar kedly affect the quality of the how velocity recordings, The purpose o f this article is to provide the technical information for performing a systematic and comprehensive Doppler evaluation of LV diastolic func tion that can be used on a routine basis. This information includes di scussing the different how velocity recordings required for a Doppler assessment of LV diastolic function, their proper recording technique, and the common technical pitfalls.