Lack of Relationship Between Doppler Indices of Diastolic
Lack of Relationship Between Doppler Indices of Diastolic
Objectives: The purpose of this study was to compare invasive with noninvasive indices of diastolic function in a well-defined group of patients with diastolic dysfunction and a history of diastolic heart failure.
Background: Patients with heart failure and a normal left ventricular (LV) ejection fraction comprise a very large portion of the heart failure population and most are thought to have diastolic heart failure. While clinical and Doppler criteria for diastolic dysfunction and diastolic heart failure have been developed, there remains some controversy about the need for invasive cardiac catheterization and/or echo-Doppler evaluation of LV diastolic function. To date, there is no consensus as to the utility of these 2 methods in the diagnosis of diastolic heart failure.
Methods: Forty-seven patients (mean age 58 ± 11 years) with a history of congestive heart failure and preserved ejection fraction (≥50%) by echocardiography underwent a combined hemodynamic/echo-Doppler study. Patients with coronary disease were excluded. Invasive parameters of LV diastolic function (tau, LV diastolic pressures) and Doppler parameters (peak E, peak A, E/A ratio, isovolumic relaxation time, and E deceleration time) were measured using standard techniques.
Results: There was a close correlation between invasively-determined parameters (tau vs end diastolic pressure: r = 0.62, P < .001). The relationships between standard Doppler parameters and LV diastolic pressures were uniformly poor. However, the relationship between Doppler isovolumic relaxation time and tau improved considerably when patients were subgrouped by hemodynamic load.
Conclusions: Standard echo-Doppler indices of diastolic function correlate poorly with LV diastolic pressure transients. The diagnosis of diastolic heart failure cannot be made on the basis of a single echo-Doppler parameter but, rather, all parameters must be examined in concert and used in combination with clinical observations.
Patients with heart failure and a normal left ventricular (LV) ejection fraction comprise a very large portion of the heart failure population. Many, if not most, such patients are said to have diastolic heart failure. Diagnostic criteria for diastolic heart failure have been developed by a European study group, and by Vasan and Levy, and Doppler echocardiographic criteria have been published by others. However, there remains some controversy about the need for invasive cardiac catheterization and/or echo-Doppler evaluation of LV diastolic function, and there is no consensus as to the utility of these 2 methods in the diagnosis of diastolic heart failure. Because invasive measures of diastolic function are impractical in most patients, echo-Doppler methods are generally favored in clinical investigation and practice. The purpose of this study was to compare results of invasive and noninvasive techniques in a well-defined group of patients with diastolic dysfunction and a history of diastolic heart failure.
Objectives: The purpose of this study was to compare invasive with noninvasive indices of diastolic function in a well-defined group of patients with diastolic dysfunction and a history of diastolic heart failure.
Background: Patients with heart failure and a normal left ventricular (LV) ejection fraction comprise a very large portion of the heart failure population and most are thought to have diastolic heart failure. While clinical and Doppler criteria for diastolic dysfunction and diastolic heart failure have been developed, there remains some controversy about the need for invasive cardiac catheterization and/or echo-Doppler evaluation of LV diastolic function. To date, there is no consensus as to the utility of these 2 methods in the diagnosis of diastolic heart failure.
Methods: Forty-seven patients (mean age 58 ± 11 years) with a history of congestive heart failure and preserved ejection fraction (≥50%) by echocardiography underwent a combined hemodynamic/echo-Doppler study. Patients with coronary disease were excluded. Invasive parameters of LV diastolic function (tau, LV diastolic pressures) and Doppler parameters (peak E, peak A, E/A ratio, isovolumic relaxation time, and E deceleration time) were measured using standard techniques.
Results: There was a close correlation between invasively-determined parameters (tau vs end diastolic pressure: r = 0.62, P < .001). The relationships between standard Doppler parameters and LV diastolic pressures were uniformly poor. However, the relationship between Doppler isovolumic relaxation time and tau improved considerably when patients were subgrouped by hemodynamic load.
Conclusions: Standard echo-Doppler indices of diastolic function correlate poorly with LV diastolic pressure transients. The diagnosis of diastolic heart failure cannot be made on the basis of a single echo-Doppler parameter but, rather, all parameters must be examined in concert and used in combination with clinical observations.
Patients with heart failure and a normal left ventricular (LV) ejection fraction comprise a very large portion of the heart failure population. Many, if not most, such patients are said to have diastolic heart failure. Diagnostic criteria for diastolic heart failure have been developed by a European study group, and by Vasan and Levy, and Doppler echocardiographic criteria have been published by others. However, there remains some controversy about the need for invasive cardiac catheterization and/or echo-Doppler evaluation of LV diastolic function, and there is no consensus as to the utility of these 2 methods in the diagnosis of diastolic heart failure. Because invasive measures of diastolic function are impractical in most patients, echo-Doppler methods are generally favored in clinical investigation and practice. The purpose of this study was to compare results of invasive and noninvasive techniques in a well-defined group of patients with diastolic dysfunction and a history of diastolic heart failure.
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