Evaluation of diastolic function by tissue Doppler

Evaluation of diastolic function by tissue Doppler

Evaluation of diastolic function by tissue Doppler: Conventionally, Doppler evaluation of diastolic function is by assessing the mitral flow velocities in diastole. But this has inherent limitation as being highly dependent on ventricular preload. Tissue Doppler techniques for assessment of ventricular diastolic function is less load dependent than mitral inflow velocities. Ea is the early myocardial relaxation velocity as the mitral annulus ascend during the initial rapid filling phase of ventricular diastole. Highest Ea measured from any aspect of the mitral annulus from apical views is termed the peak Ea velocity. It is more likely at the lateral annulus, with septal Ea velocity being slightly lower. Ea velocity measured from the lateral annulus less than eight centimeters per second in older adults would indicate impaired left ventricular relaxation (diastolic dysfunction). Since Ea is relatively resistant to changes in left ventricular filling pressure, this can be used to differentiate normal from a pseudonormal mitral inflow pattern. In a study by Tudor C Poerner, Björn Goebel, Petra Unglaub, Tim Sueselbeck, Jörg M Strotmann, Stefan Pfleger, Martin Borggrefe and Karl K Haase pseudonormalization was found in 46 of 98 patients [1].

Reversal of Em / Am (less than one) and an absolute value of Em less than eight centimeters per second are also indicative of diastolic dysfunction.

Reference

1. Tudor C Poerner, Björn Goebel, Petra Unglaub, Tim Sueselbeck, Jörg M Strotmann, Stefan Pfleger, Martin Borggrefe, Karl K Haase. Detection of a Pseudonormal Mitral Inflow Pattern: An Echocardiographic and Tissue Doppler Study. Echocardiography. 2003 May;20(4):345-56.