State of the art : “Diastology” research 1998

The performance of the left ventricle (LV) during diastole is defined by the pressure-volume relationship. Consequently, noninvasive techniques have been limited in the evaluation of diastolic function by their inability to evaluate intracardiac pressure, particularly LV filling pressure and end-diastolic pressure. Abnormalities of LV diastolic function play a major role in producing the clinical signs and symptoms of heart failure. Previous studies have demonstrated that the transmitral flow (TMF), pulmonary venous flow (PVF) and left atrial appendage flow (LAAF) velocity patterns determined by pulsed Doppler echocardiography are useful parameters for evaluating left atrial (LA) and LV hemodynamic events. However, these variables are influenced by loading conditions, particularly preload. Furthermore, it has become increasingly clear that abnormalities of LV diastolic function, such as relaxation and filling, can be assessed precisely using color Doppler M-mode echocardiography and pulsed tissue Doppler imaging irrespective of preload. This review presents a clinical approach to understanding the hemodynamic abnormalities of the LA and LV in a variety of cardiac diseases using these new modalities. In addition, the limitations of these techniques are discussed.