[Echocardiographic and Doppler echocardiographic characterization of left ventricular diastolic function]

For noninvasive assessment of diastolic ventricular function, in addition to echocardiography, more recently, in particular, Doppler echocardiography has been employed. M-mode echocardiogram velocity curves for diameter changes as well as Doppler-echocardiographically registered velocity curves of mitral flow characterize the temporal changes of diastolic flow into the left ventricle. They represent the overall result of factors which influence diastolic filling and are functions of the temporal course of the pressure difference between left atrium and left ventricle. Registration of M-mode and Doppler echocardiograms: For determination of M-mode parameters which should describe left ventricular diastolic function, in addition to the motion of the mitral valve, the left ventricular contours of septum and posterior wall between mitral leaflets and papillary muscles are recorded together with the ECG. For evaluation of the index of atrial emptying, an M-mode registration is obtained from the region of the aortic root. Determination of the Doppler echocardiographic parameters is based on analysis of the blood flow velocity in the region of the mitral valve in the apical four-chamber view with the pulsed Doppler method. Additionally, simultaneous to the Doppler curve, a phonocardiogram is registered or, alternatively, a continuous-wave Doppler registration is obtained which delineates the left ventricular outflow signal and the artefact of mitral valve opening. Parameters for characterization of left ventricular diastolic filling: The first peak of the velocity curve of the diameter change in the M-mode echocardiogram corresponds with the maximal diameter change resulting from early-diastolic filling and the second peak with the maximal diameter change of the left ventricle associated with atrial filling. From this curve as well as the diameter curve relative to time and the mitral valve motion, the times for isovolumetric relaxation as well as the rapid, slow and atrial filling phase which characterize the ventricular filling and the diameter changes of the left ventricle during these time intervals can be derived. The maximal velocity of the diastolic diameter change (PFR) is used to characterize the maximal early diastolic flow. The atrial emptying index characterizes the fraction of filling volume in the first third of diastole with respect to total filling volume of the left ventricle. As an indirect parameter for description of the early-diastolic filling, the steepness of the early-diastolic closure of the anterior mitral leaflet is used. From Doppler velocity profiles of the mitral inflow, early and late diastolic maximal velocities and their velocity time integrals as well as the relationships of these parameters to each other are determined.(ABSTRACT TRUNCATED AT 400 WORDS)