1. Echocardiographic Evaluation of LV Diastolic Function Natalie Bello, M.D. October 14, 2009

2. Objectives Defining Diastole Diastolic Function Measurements Diastolic Function Grades

3. Diastology: The science and art of characterizing left ventricular relaxation, filling dynamics, and their integration into clinical practice.

4. What is Diastole? Insert Otto Figure 7-1 +/- 7-2

6. Objectives Defining Diastole Diastolic Function Measurements Diastolic Function Grades

7. Transmitral Doppler Inflow http://www.echobasics.de/diastole-en.html

8. IVRT

10. http://www.echobasics.de/diastole-en.html Tissue Doppler Imaging (e’)

11. E/e’ ratio (combo of transmitral flow velocity and annular velocity) is best parameter for predicting mean LVEDP ( 15 abnl); but cannot be used in isolation!

12. http://www.echobasics.de/diastole-en.html Pulmonary Venous Doppler Flow

13. Mitral Inflow Propagation Velocity (Vp) http://www.echobasics.de/diastole-en.html

14. Global Strain Rate (SRivr) Wang et al Global Diastolic SR for LV Relaxation Circ. 2007; 115:1376-1383.

15. LA Volume Barometer of the chronicity of diastolic dysfunction. LA volume correlates with risk of cardiovascular events including MI, CVA, A fib and CHF. More stable than LV filling pressures. Douglas PS. The left atrium: a biomarker of chronic diastolic dysfunction and cardiovascular disease risk. JACC 2002;42:1206-7.

16. Objectives Defining Diastole Diastolic Function Measurements Diastolic Function Grades

18. BIDMC Echo Lab Decel Time 140-250ms E/e’: <8 normal E/e’>15 (LVEDP>18mmHg)

19. Approach to the Patient

21. Summary Diastole is a complex, energy dependent process. Echo indices of diastolic fn include: –Transmitral Doppler inflow –Tissue Doppler velocities –Pulmonary venous Doppler flow –Color M-mode propagation velocity Diastolic dysfunction is a measurable, step-wise progression from normal to irreversible.

22. References Otto CM. Textbook of clinical echocardiography, 4 th Edition. Douglas PS. The left atrium: a biomarker of chronic diastolic dysfunction and relation to cardiovascular risk burden. JACC 2002;40:1206-7. http://www.echobasics.de/diastole-en.html Lester SJ, Tajik AJ, Nishimura RA, et al. Unlocking the mysteries of diastolic function. JACC 2008;51:679-89. Nagueh SF, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am S Echo 2009;22:107-33 Nishimura RA, Tajik AJ. Evaluation of diastolic filling of left ventricle in health and disease: Doppler echocardiography is the clinician’s Rosetta Stone. JACC 1997;30:8-18. Ommen SR, Nishimura RA, Appleton CP, et al. Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: a comparative simultaneous Doppler- catheterization study. Circ. 2000;102:1788-94. Wang J, Khoury DS, Thohan V, Torre-Amione G, Nagueh SF. Global diastolic strain rate for the assessment of left ventricular relaxation and filling pressures. Circ. 2007;115:1376-83.