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Diastolic function of the heart in clinical cardiology
R C Harizi1, J A Bianco, J S Alpert
1Department of Medicine and Nuclear Medicine, University of Massachusetts Medical Center, Worcester.
Insights
Noninvasive methods like radionuclide angiography and Doppler echocardiography now detect early left ventricular diastolic dysfunction in heart disease. These techniques identify abnormalities before systolic issues arise, aiding early diagnosis.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Cardiac Physiology
Background:
- Left ventricular diastolic function assessment has evolved significantly.
- Historically, invasive catheterization was standard; noninvasive methods are now preferred.
- Diastolic abnormalities can precede systolic dysfunction in various heart conditions.
Purpose of the Study:
- To review the advancements in detecting left ventricular diastolic dysfunction.
- To highlight the utility of noninvasive techniques in early disease detection.
- To discuss the implications of diastolic function assessment in cardiology.
Main Methods:
- Radionuclide angiography and Doppler echocardiography are key noninvasive tools.
- These methods measure the dynamics of left ventricular filling.
- Studies analyze diastolic function in patients with ischemic heart disease, hypertension, and hypertrophic cardiomyopathy.
Main Results:
- Noninvasive methods are accurate, reproducible, and easy to perform.
- Diastolic abnormalities can be detected early, even before systolic changes.
- These findings suggest potential for early disease identification and monitoring.
Conclusions:
- Left ventricular diastolic function assessment is crucial for comprehensive cardiac evaluation.
- Noninvasive techniques offer valuable insights into early cardiac disease.
- Further research is needed to standardize methods and evaluate therapeutic efficacy.
Abstract:
During the last six years, there has been increased interest in the detection of abnormalities of left ventricular diastolic function in patients with heart disease. Before 1981, most studies on diastolic function were performed in the catheter laboratory using invasive techniques and complex methods. Recently, radionuclide angiograms and Doppler echocardiography have been employed to measure the dynamics of filling in normal individuals and in patients with heart disease. These methods are noninvasive, easy to perform, accurate, and reproducible. It is now clear that diastolic function may be altered globally and regionally, at rest and perhaps during exercise, in many patients with ischemic heart disease, hypertension, and hypertrophic cardiomyopathy. Interestingly, these diastolic abnormalities may even appear before systolic abnormalities are identified in these patients. Thus, diastolic abnormalities may permit assessment of presence of disease early in its evolution. Whether detection and quantitation of diastolic abnormalities will permit grading of disease severity or evaluation of therapeutic efficacy remains an important research question. At the present time, it appears that the decision to employ either radionuclide angiography or Doppler echocardiography for the assessment of diastolic abnormalities will depend on the local expertise to carry out the investigation. Both diagnostic modalities require standardization of accuracy and reproducibility with proper selection of control values from the appropriate populations of normal individuals. It is also important to remember that left ventricular diastolic abnormalities have to be identified after the elimination of the confounding influence of variables such as ejection fraction, heart rate, age, and preload (end-diastolic volume). Automation of the derivation of indexes of diastolic filling should provide an objective assessment of the dynamics of left ventricular filling. Although the value of measurement of diastolic filling in the individual patient remains controversial, we believe that the practice of cardiology is incomplete without consideration of the second half of cardiac function.