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Pre- and post-operative diastolic dysfunction in patients with valvular heart disease: diagnosis and therapeutic

Rasheed R Zaid1, Colin M Barker1, Stephen H Little1

  • 1Methodist DeBakey Heart and Vascular Center, Methodist Hospital, Houston, Texas.

Journal of the American College of Cardiology
|September 24, 2013
PubMed

Insights

Left ventricular diastolic dysfunction is common in valvular heart disease. Timely surgical intervention often improves this condition, though complete normalization of function is not always achieved.

Area of Science:

  • Cardiology
  • Cardiovascular Physiology

Background:

  • Left ventricular diastolic dysfunction is a frequent complication in patients with valvular heart disease.
  • Understanding the mechanisms is crucial for effective management.

Purpose of the Study:

  • To review the mechanisms of diastolic dysfunction in mitral and aortic valve disease.
  • To discuss diagnostic modalities and therapeutic approaches.

Main Methods:

  • Literature review focusing on valvular heart disease and diastolic dysfunction.
  • Analysis of underlying myocardial abnormalities, diagnostic tools, and treatment strategies.

Main Results:

  • Diastolic dysfunction involves intrinsic myocardial abnormalities (sarcomeric proteins, calcium handling, fibrosis) beyond altered loading conditions.
  • Echocardiography is the primary diagnostic tool, with cardiac MRI and catheterization used when necessary.
  • Medical therapy's clinical utility is not well-established, but surgical intervention often improves diastolic function.

Conclusions:

  • Valvular heart disease frequently causes left ventricular diastolic dysfunction through various mechanisms.
  • A comprehensive diagnostic approach is essential for assessing diastolic function and filling pressures.
  • Surgical correction of valve disease is the most effective treatment for improving diastolic dysfunction.

Keywords:
ARASAVRArCMRDTEDPEDVEFIVRTLALVMRMSPAaorticaortic regurgitationaortic stenosisaortic valve replacementatrial reversal velocitycardiac magnetic resonancedeceleration timediastolicejection fractionend-diastolic pressureend-diastolic volumeisovolumic relaxation timeleft atrialleft ventricularmitral regurgitationmitral stenosispulmonary arterysurgeryvalvular

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