Diastology: 2020‐A practical guide

心脏病学 内科学 舒张期 医学 心房颤动 心力衰竭 多普勒超声心动图 舒张功能 血压
作者
Sherif F. Nagueh
出处
期刊:Echocardiography-a Journal of Cardiovascular Ultrasound and Allied Techniques [Wiley]
卷期号:37 (11): 1919-1925 被引量:21
标识
DOI:10.1111/echo.14742
摘要

Abstract Left ventricular (LV) diastolic function can be most conveniently assessed by echocardiography which provides reliable assessments of LV structure and function. Most patients with structural heart disease have variable degrees of myocardial dysfunction. LV structural changes as pathologic hypertrophy and systolic functional abnormalities as depressed LV long‐axis systolic function are associated with diastolic dysfunction. The recognition of structural abnormalities and abnormal LV long‐axis function as indices of diastolic dysfunction is an important difference between 2016 and 2009 guidelines. In addition, there are other Doppler findings indicative of diastolic dysfunction and abnormally elevated LV filling pressures. In the absence of clinical, 2D echocardiographic, and specific Doppler indices of diastolic dysfunction, mitral annulus early diastolic velocity (e’), left atrium (LA) maximum volume index, peak velocity of tricuspid regurgitation jet by continuous‐wave Doppler, and ratio of mitral inflow early diastolic velocity to e’ velocity can be used to draw inferences about LV diastolic function. In the presence of diastolic dysfunction, mean LA pressure and grade of diastolic dysfunction should be determined. When LA pressure at rest is normal, it is reasonable to proceed to diastolic stress testing in an attempt to identify patients with dyspnea due to heart failure. There are specific algorithms recommended in patients with atrial fibrillation, moderate or severe mitral annular calcification, and noncardiac pulmonary hypertension.
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