Challenges for 'diastology': contributions from Japanese researchers
Takashi Oki1, Hirokazu Miyoshi2, Yoshifumi Oishi2
1Cardiovascular Section, Higashi Tokushima Medical Center, National Hospital Organization, Tokushima, Japan. oki@higasitokusima.hosp.go.jp.
Insights
Diastology utilizes advanced echocardiography to assess heart diastolic function. New techniques like speckle tracking can detect impaired heart and arterial coupling before heart failure symptoms appear.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Diastology
Background:
- Left ventricular (LV) diastolic dysfunction impacts heart function.
- Assessing diastolic function is crucial for managing heart conditions.
- Traditional methods have limitations in evaluating diastolic dysfunction.
Purpose of the Study:
- To explore advanced echocardiographic methods for evaluating diastolic function.
- To investigate the role of tissue Doppler and speckle tracking in assessing LV diastolic dysfunction.
- To characterize LA-LV-arterial coupling and its early detection.
Main Methods:
- Pulsed Doppler echocardiography for transmitral and pulmonary venous flow.
- Tissue Doppler echocardiography for mitral annular and LV wall motion.
- Two-dimensional speckle tracking echocardiography for myocardial and arterial deformation.
Main Results:
- Tissue Doppler indices are relatively preload independent for assessing relaxation.
- Speckle tracking evaluates multi-directional myocardial and arterial mechanics.
- Early detection of impaired LA-LV-arterial coupling is possible.
Conclusions:
- Advanced echocardiography offers superior insights into diastolic function compared to catheterization.
- Tissue Doppler and speckle tracking are valuable tools for assessing diastolic dysfunction.
- Early identification of impaired coupling may prevent heart failure progression.
Abstract:
Diastology is a study to treat diastole of the heart. Transmitral flow and pulmonary venous flow velocities recorded by pulsed Doppler echocardiography provide more important information about left ventricular (LV) diastolic dysfunction [left atrial (LA)-LV coupling] than cardiac catheterization in clinical practice; however, these waveforms are influenced by loading conditions, particularly preload. The early diastolic mitral annular and LV wall motion indices measured by tissue Doppler echocardiography can evaluate LV relaxation abnormality and filling pressure by being relatively preload independent. In addition, the role of concomitant systolic longitudinal dysfunction is well characterized in asymptomatic patients and in patients with heart failure and preserved ejection fraction. Two-dimensional speckle tracking echocardiography is an angle-independent method, and has the potential to evaluate the contraction and relaxation abnormalities in the longitudinal, circumferential, and radial directions of the LV myocardium as well as LV torsion/untwisting and, moreover, deformation of the LA myocardium and large arterial wall. As a result, this new technique can facilitate the early detection of impaired LA-LV-arterial coupling in patients before occurrence of overt heart failure symptoms.
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