Echocardiographic evaluation of left ventricular diastolic function

Abstract

There is increasing interest in left ventricular diastolic function, which can be profoundly influenced by many disease states, such as hypertension, hypertrophic cardiomyopathy. infiltrative cardiomyopathy and ischemic heart disease. In some of these conditions, altered diastolic filling of the left ventricle is the principal functional abnormality and is responsible for the patient’s symptoms. M-Mode echocardiographic techniques. Since it was first developed, echocardiography has been used to study left ventricular filling. The initial widely accepted clinical application of echocardiography was the M-mode appearance of the mitral valve in mitral stenosis. Edler (1) observed that normally the mitral valve opened abruptly with the onset of diastole. closed rapidly during early diastole and then reopened with atria1 systole. This early investigator noted that with mitral stenosis this closing pattern of the valve was altered. and the anterior leaflet of the mitral valve no longer closed rapidly in early diastole. This finding, which was measured by the rate of mitral valve closure or the diastolic E to F slope, was believed to be diagnostic of mitral stenosis and was quantitatively related to the severity of the stenosis (2). The mitral E to F slope proved not to be specific for mitral stenosis (3); this altered motion of the mitral leaflet essentially reflected left ventricular filling. Reduced E to F slopes were found in other disease states that were characterized by reduced left ventricular compliance (4,.5). Thus the M-mode echocardiographic mitral valve E to F slope was one of the first clinically useful measures of left ventricular filling. Another M-mode c~chocLlrdioXraphic ohsertwtion that M‘NS related to diastolic left ventricular firnction was mitral wrll~~ closare ajier atria1 systole (6). Normally, mitral closure is initiated by left atria1 relaxation and is completed with