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Diastolic Function & Filling Pressures in Heart Failure: Echocardiography, Slides of Cardiology

An in-depth analysis of echocardiography findings in heart failure with normal ejection fraction (hfnef), focusing on the assessment of diastolic function and filling pressures. The normal and abnormal diastolic function, the importance of determining diastolic properties, and the comprehensive use of echocardiography techniques such as m-mode, two-dimensional, doppler, color m-mode, and myocardial imaging.

Typology: Slides

2011/2012

Uploaded on 10/19/2012

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Echocardiography findings
in HFNEF
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Echocardiography findings

in HFNEF

DHF OR HFNEF

  • Mauer et al.

DHF

  • LVEF is normal on two-dimensional

echocardiography clinical evidence of heart failure.

  • The diagnosis can be confirmed if Doppler

echocardiography and myocardial tissue imaging.

NORMAL AND ABNORMAL DIASTOLIC FUNCTION

  • Normal diastolic function allows adequate filling of the ventricles during rest and exercise without abnormal increase in diastolic pressures.
  • The normal response to exercise is lost in heart failure regardless of EF.
  • Under these circumstances, relaxation of myocardium is slowed with decreased or no ability to enhance relaxation with exercise.
  • Thus, LV early diastolic pressure does not decline during exercise but, in fact, increases.
  • In patients with diastolic dysfunction, increases in LV filling in response to exercise are dependent on increases in left atrial pressure.
  • Whether the LV filling is normal with a good myocardial relaxation or LV filling is dependent on left atrial pressure can be easily discerned by two-dimensional and Doppler parameters measured in a daily echocardiography practice, which are used to determine myocardial relaxation, compliance, and filling pressure at rest and with exercise.

Comprehensive echocardiography

  • M-mode,
  • Two-dimensional,
  • Doppler,
  • Color M-mode, and
  • Myocardial (tissue Doppler) imaging.

Two-dimensional

echocardiography

  • LA size
  • LV thickness
  • LVEF
  • Other structural heart diseases

Diastolic Heart Failure - Comprehensive Two-Dimensional and Doppler Echocardiography

  • Impaired myocardial relaxation -decreased longitudinal velocity of the mitral annulus during early diastole (Ea) and -decreased propagation velocity mitral inflow (Vp),
  • Decreased compliance -shortened mitral A-wave duration and -mitral deceleration time (DT),
  • Increased filling pressure -shortened isovolumic relaxation time (IVRT) and -an increased ratio between early diastolic mitral and mitral annular velocities (E/Ea).