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Diastole in clinical practice

The session started with a conference by Dr T. Kukulski (Zabrze, Poland) who gave an overview about how to evaluate left ventricular (LV) diastolic function in clinical practice.
He stressed the importance of the topic in the context of the high prevalence of heart failure with preserved ejection fraction. He then discussed the different modalities applied (structural and Doppler evaluation), with the pros and cons, putting technical aspects into clinical perspective.
This conference was followed by 4 presentations based on challenging clinical cases.

Dr A. Brown (Dublin, Ireland) presented four cases to illustrate the common challenge of differentiating constriction from restriction. She discussed in a clear way the physiopathology behind the different echo signs used in this regard. The critical importance of a comprehensive approach including a detailed clinical assessment was underlined. The role of non-echo imaging modalities was also discussed.

Dr F. Flachskampf (Uppsala, Sweden) commented on the assessment of diastolic function in patients with LV systolic dysfunction. In such a setting, assessment mainly aims to estimate the LV filling pressures. The role of different echo parameters was discussed in the context of two illustrative cases. In cases where several parameters are in the intermediate grey-zone, the potential role of calculating the TE-e’ interval was discussed.

Dr J.E. Moller (Odense, Denmark) presented the assessment of diastolic function in patients with valvular heart disease. While in aortic stenosis the role of the E/e’ ratio and LA volume are established and may provide prognostic information, few data have been validated in aortic regurgitation. In patients with mitral regurgitation or mitral stenosis, many of the conventional echo parameters cannot be applied. The role of measuring the TE-e’ interval was again discussed as an option in such patients.

Finally, Dr A. Iliesiu (Bucharest, Romania) commented on the assessment of diastolic function in patients with atrial fibrillation. Many of the usual parameters (e.g. LA volume, parameters based on the A or Ar waves) cannot be used in this setting. Thus, the importance of a comprehensive approach, performed at a controlled heart rate averaging several beats and using a combination of parameters was underlined and illustrated with several interesting clinical cases.

Bogdan A. Popescu, Bucharest, Romania




Diastole in clinical practice

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.