[Predictive significance of evaluation of left ventricular diastolic function in patients with heart failure]

Pulsed-Doppler derived transmitral flow (TMF) has been widely used for evaluating left ventricular (LV) diastolic function. The grading of LV diastolic dysfunction is feasible by the ratio of early to late diastolic inflow velocities (E/A): normal: E/A > 1, grade I: E/A < 1 (abnormal relaxation pattern), grade II: E/A > 1 (pseudonormal pattern), grade III: E/A > > 1 (restrictive pattern), and grade IV: E/A > > 1 (irreversible restrictive pattern). Pulmonary venous flow pattern is also used for evaluation of LV diastolic dysfunction, especially to differentiate a normal from pseudonormal TMF pattern. The ratio of systolic to diastolic pulmonary venous flow (S/D) >1 is normal and S/D < 1 is regarded as pseudonormal. Recently, tissue Doppler imaging (TDI) has been introduced as a new diagnostic tool for LV diastolic dysfunction. The mitral annular velocity obtained by TDI is used for a preload-independent index of LV diastolic function. The ratio of early transmitral inflow to mitral annular velocity (E/Ea) related well to pulmonary capillary wedge pressure. In particular, E/Ea > 15 strongly suggested elevated PCWP and LV filling pressure. Therefore, analysis of TMF and PVF patterns by pulsed Doppler and Ea by TDI is useful for diagnosing the uncompensated state of heart failure. Furthermore, the TMF pattern is utilized to predict the prognosis of patients with heart failure. Patients with an irreversible restrictive filling pattern have high mortality, whereas those with, reversible restrictive filling have a high probability of improvement of heart failure.