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Invasive evaluation of left ventricular diastolic performance.
W C Little1, T R Downes, R J Applegate
1Department of Medicine, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, North Carolina.
Herz
|December 1, 1990
Summary
Diastolic dysfunction, often causing pulmonary congestion, arises from impaired left ventricular (LV) relaxation or altered passive LV properties. Recognizing filling patterns is key to diagnosing diastolic dysfunction, even with normal systolic function.
Area of Science:
- Cardiology
- Physiology
Background:
- Diastole, the heart's relaxation phase, involves four phases: isovolumic relaxation, early filling, diastasis, and atrial systole.
- Normal diastolic function ensures adequate cardiac output and maintains pulmonary venous pressure below 12 mm Hg.
- Diastolic dysfunction typically manifests as pulmonary congestion, often due to impaired myocardial relaxation or altered left ventricular (LV) passive properties.
Purpose of the Study:
- To elucidate the mechanisms and diagnostic patterns of diastolic dysfunction.
- To highlight the importance of assessing diastolic filling patterns in relation to clinical presentation.
Main Methods:
- Invasive studies quantifying myocardial relaxation rate and LV diastolic pressure-volume relations.
- Frame-by-frame analysis of contrast ventriculography and LV volume conductance to assess diastolic filling patterns.
Main Results:
- Normal diastolic filling predominantly occurs early in diastole.
- Conditions like LV hypertrophy and ischemia reduce early diastolic filling, increasing reliance on atrial systole.
- Reduced early diastolic filling without pulmonary congestion signifies loss of diastolic reserve.
Conclusions:
- Diastolic dysfunction can be identified by altered LV diastolic filling patterns, even with preserved systolic function.
- Recognizing these patterns is crucial for diagnosing diastolic dysfunction and managing heart failure.
- Atrial systole augmentation and reduced early filling are indicative of diastolic dysfunction, especially in symptomatic patients.