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

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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).