Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging

Extract

Echocardiographic assessment of left ventricular (LV) diastolic function is an integral part of the routine evaluation of patients presenting with symptoms of dyspnea or heart failure. The 2009 American Society of Echocardiography (ASE) and European Association of Echocardiography (now European Association of Cardiovascular Imaging [EACVI]) guidelines for diastolic function assessment were comprehensive, including several two-dimensional (2D) and Doppler parameters to grade diastolic dysfunction and to estimate LV filling pressures.¹ Notwithstanding, the inclusion of many parameters in the guidelines was perceived to render diastolic function assessment too complex, because several readers have interpreted the guidelines as mandating all the listed parameters in the document to fall within specified values before assigning a specific grade. The primary goal of this update is to simplify the approach and thus increase the utility of the guidelines in daily clinical practice.

LV diastolic dysfunction is usually the result of impaired LV relaxation with or without reduced restoring forces (and early diastolic suction), and increased LV chamber stiffness, which increase cardiac filling pressures. Thus, when performing an echocardiographic study in patients with potential diastolic dysfunction, one should search for signs of impaired LV relaxation, reduced restoring forces and increased diastolic stiffness. More important, LV filling pressure should be estimated because elevated LV diastolic pressure in the absence of increased LV end-diastolic volume is strong evidence in favor of well-developed diastolic dysfunction. In the majority of clinical studies, LV filling pressures and diastolic function grade can be determined reliably by a few simple echocardiographic parameters with a high feasibility. In addition, technical developments have emerged that provide new indices that appear promising for studying LV diastolic function. This update places more emphasis on applying the most useful, reproducible, and feasible 2D and Doppler measurements from the 2009 guidelines.