Echocardiography: future developments. What is diastole and how to assess it? Impaired left ventricular systolic...

Epidemiologic data show that diastolic heart failure is responsible for 38% to 54% of all heart failure cases. Left ventricular diastolic function can be characterized invasively in the catheter laboratory and non-invasively by echocardiography. Although echocardiography does not directly measure hemodynamic parameters, it is the most practical routine clinical approach for the evaluation of left ventricular diastolic function with given clinical and experimental evidence supporting its use as well as its safety, versatility, and portability. A set of echocardiographic paramters suitable for the description of diastolic function has been investigated or is still under investigation. Two guideline-papers exist with regard to the assessment of diastolic function, diastolic dysfunction and diastolic heart failure. Mitral inflow pattern, isovolumetric relaxation time, flow propagation velocity, tissue Doppler imaging and pulmonary vein flow pattern are central parameters established for the assessment of diastolic function, estimation of left atrial pressure and left ventricular enddiastolic pressure. Furthermore, calculated parameters, e.g. like E/E´, E/Vp, AR-A, for a more accurate determination of diastolic dysfunction have been evaluated. With respect to recent guidelines and recommendations, this review summarizes the physiology and pathophysiology of diastole, current echocardiographic methods and calculated echocardiographic parameters for the assessment of left ventricular diastolic function and dysfunction. In addition, an overview of the current state of research with regard to the echocardiographic assessment of left ventricular diastolic function will be given.