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Echocardiographic diagnosis of LV diastolic dysfunction, imaging

ESC Congress session report 2008

Evaluation of diastolic function remains a challenge for the clinician due to the large number of different available parameters. In this session, 4 experts defended their viewpoint.

Non-Invasive Imaging


Assessing diastolic function: will the ideal test please stand up?

Dr. D Leung (Sydney, AU) emphasized the weak points of conventional methods such as the transmitral inflow which is age-dependent and only reflects instantaneous diastolic function. Even tissue velocity imaging has drawbacks such as angle dependency. As an alternative, he suggested the use of the left atrial volume -highly reproducible - if measured with the biplane method. Left atrial enlargement is not part of normal ageing and truly reflects diastolic dysfunction. Moreover, it offers prognostic information.

Dr. O. Smiseth (Oslo, NO) addressed novel myocardial deformation techniques such as velocity derived strain, speckle tracking and torsion-twisting. Although these techniques are interesting research tools, they are not ready for routine use. Pulsed wave early diastolic velocity (E’) however, is ready for clinical practice. Dr. Smiseth advised to measure E’ at the septal and lateral mitral valve annulus and to average these values. An E/E’ ≥ 15 reflects elevated filling pressures.

According to Dr. A. Fraser (Cardiff, UK), there is still a place for transmitral flow pattern and pulmonary vein flow, provided that the information is integrated with other parameters such as E/E’. He also addressed an exciting new issue: evaluating diastolic function using semi-supine exercise echocardiography.

In his presentation, Dr. E. Nagel (Berlin, DE), demonstrated the additional value of using MRI to evaluate diastolic function. Rotation-volume loops provide interesting pathophysiological information. MRI is also an excellent tool to help with the underlying causes such as hypertrophic cardiomyopathy, inflammatory myocarditis and pericardial disease.

Conclusion:

There is no ideal test to diagnosis diastolic dysfunction. Diastolic function should be assessed by integrating simple tools (left atrial volume, mitral inflow, pulmonary venous flow) and more advanced tools (pulsed wave TDI). MRI provides additional diagnostic information.

References


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SessionTitle:

Echocardiographic diagnosis of left ventricular diastolic dysfunction Clinical Seminar

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.