Review Articles
New Doppler echocardiographic applications for the study of diastolic function

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Abstract

Doppler echocardiography is one of the most useful clinical tools for the assessment of left ventricular (LV) diastolic function. Doppler indices of LV filling and pulmonary venous (PV) flow are used not only for diagnostic purposes but also for establishing prognosis and evaluating the effect of therapeutic interventions. The utility of these indices is limited, however, by the confounding effects of different physiologic variables such as LV relaxation, compliance and filling pressure. Since alterations in these variables result in changes in Doppler indices of opposite direction, it is often difficult to determine the status of a given variable when a specific Doppler filling pattern is observed. Recently, color M-mode and tissue Doppler have provided useful insights in the study of diastolic function. These new Doppler applications have been shown to provide an accurate estimate of LV relaxation and appear to be relatively insensitive to the effects of preload compensation. This review will focus on the complementary role of color M-mode and tissue Doppler echocardiography and traditional Doppler indices of LV filling and PV flow in the assessment of diastolic function.

Abbreviations

Am
peak diastolic myocardial velocity during atrial contraction
AR
peak pulmonary venous atrial reversal velocity
D
peak diastolic pulmonary venous flow velocity
DT
early filling deceleration time
E
peak early transmitral flow velocity
Em
peak early diastolic myocardial velocity
IVRT
isovolumic relaxation time
LA
left atrial
LV
left ventricular
PV
pulmonary vein
S
peak systolic pulmonary venous flow
Sm
peak systolic myocardial velocity
τ
time constant of isovolumic relaxation
TD
color M-mode time delay to apical filling
TDE
tissue Doppler echocardiography
Vp
color M-mode flow propagation velocity

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Supported in part by Grant-in-aid #NEO-97-225-BGIA from the American Heart Association, North-East Ohio Affiliate (M.G.), National Aeronautics Space Administration Grant # NCC9-60, Houston, Texas (J.D.T., M.G.) and National Institute of Health Grant # ROI HL56688-01A1, Bethesda, Maryland (J.D.T.).