Assessment of Diastolic Function of the Heart: Background and Current Applications of Doppler Echocardiography. Part I. Physiologic and Pathophysiologic Features

doi:10.1016/S0025-6196(12)65305-1

Mayo Clinic Proceedings

Volume 64, Issue 1, January 1989, Pages 71-81

https://doi.org/10.1016/S0025-6196(12)65305-1 Get rights and content

In the past, evaluation of the myocardium has been limited to examining systolic function of the heart. Recently, however, investigators have demonstrated that abnormalities of diastolic function of the heart provide important contributions to the signs and symptoms experienced by patients with heart disease. In addition, abnormalities of diastolic function may precede abnormalities of systolic function in the early stages of disease. Diastolic filling of the heart, however, is a complex sequence of interrelated events. In order to understand diastolic function, each of these factors contributing to filling of the heart must be examined. They include relaxation, passive compliance, atrial contraction, erectile effect of the coronary arteries, viscoelastic properties, ventricular interaction, and pericardial restraint—all of which are interrelated. In addition, diastolic factors are affected by changes in loading conditions and contractility, and they demonstrate nonuniformity in time and space. This report provides an overview of these various factors from the clinical perspective, based on studies involving the isolated papillary muscle and the isolated heart as well as basic clinical studies.

Section snippets

DEFINITION

The term “diastole” originates from a Greek word that means a drawing asunder or expansion of the heart. The clinical definition of diastole involves the time period beginning at end-ejection (closure of the semilunar valves) and extending until the atrioventricular valves close. For the left ventricle, the duration of diastole is from aortic valve closure to mitral valve closure. Diastole has been further divided into (1) the isovolumic relaxation period (aortic valve closure to mitral valve

PHYSIOLOGIC AND PATHOPHYSIOLOGIC FEATURES

The clinical principle of diastolic filling of the heart can be simply stated: there is a change in intracardiac pressure that occurs for a given change in volume. For any loading condition, heart rate, and myocardial thickness, a certain increase in pressure occurs when the ventricle fills with a specific volume. If diastolic filling of the heart is abnormal, a relatively higher intracardiac pressure may be present for a given volume. Diastolic filling may be abnormal because of changes in

CONCLUSION

Diastole is an extremely complex sequence of interrelated events that have been exclusively studied in the investigative laboratory in both the animal and the human model. Some of the factors contributing to diastolic function are myocardial relaxation, rapid and slow filling, atrial contraction, viscoelastic properties of the myocardium, diastolic suction, pericardial restraint, ventricular interaction, and the hydraulic effect of the coronary arteries. Part II of this review (which will be

ACKNOWLEDGMENT

We thank Dr. T. C. Gillebert for his valuable review of this manuscript and Denise A. Skoda for her help in preparation of the submitted manuscript.

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: This work was supported in part by Grant GM 36365 from the National Institutes of Health, Public Health Service.

^*: Part II will review the use of Doppler echocardiography in evaluating diastolic function from a clinical perspective.

View full text

Assessment of Diastolic Function of the Heart: Background and Current Applications of Doppler Echocardiography. Part I. Physiologic and Pathophysiologic Features*

Section snippets

DEFINITION

PHYSIOLOGIC AND PATHOPHYSIOLOGIC FEATURES

CONCLUSION

ACKNOWLEDGMENT

Am J Med

Am J Cardiol

Prog Cardiovasc Dis

Am Heart J

Am J Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Mayo Clin Proc

Am J Cardiol

J Am Coll Cardiol

Am J Cardiol

Prog Cardiovasc Dis

Am J Cardiol

Am Heart J

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Am J Cardiol

Am Heart J

Systolic and diastolic abnormalities of the left ventricle in coronary artery disease: studies in patients with little or no enlargement of ventricular volume

Circulation

The rate of change of left ventricular volume in man. II. Diastolic events in health and disease

Circulation

The rate of change of left ventricular volume in man. I. Validation and peak systolic ejection rate in health and disease

Circulation

Diastolic properties of the left ventricle

Ann Intern Med

Diastolic pressure-volume relations in the diseased heart

Fed Proc

Assessment of diastolic function: suggested methods and future considerations

Circulation

Factors which affect the diastolic pressure-volume curve

Circ Res

Compliance of the left ventricle (editorial)

Circulation

Pulmonary edema in coronary-artery disease without cardiomegaly: paradox of the stiff heart

N Engl J Med

Simultaneous assessment of left ventricular systolic and diastolic dysfunction during pacing-induced ischemia

Circulation

Impaired left ventricular diastolic filling in patients with coronary artery disease: assessment with radionuclide angiography

Circulation

A clinical study of left ventricular relaxation

Circulation

Effects of progressive reduction in coronary blood flow on regional and global left ventricular contraction and relaxation during normal and increased afterload: a roentgen videometric study

Cardiovasc Res

Altered left ventricular diastolic properties during pacing-induced angina in patients with aortic stenosis

Circulation

Loading and performance of the heart as muscle and pump

Cardiovasc Res

Dual control of relaxation: its role in the ventricular function in the mammalian heart

Circ Res

Ventricular relaxation

Triple control of relaxation: implications in cardiac disease

Circulation

Doppler Ultrasound in Cardiology: Physical Principles and Clinical Applications

Transmitral blood flow reflecting diastolic behavior of the left ventricle in health and disease: a study by pulsed Doppler technique

Jpn Circ J

Determination of parameters of left ventricular diastolic filling with pulsed Doppler echocardiography: comparison with cineangiography

Circulation

Excitation-contraction coupling in cardiac muscle

Prog Biophys Mol Biol

Load-dependent relaxation with late systolic volume steps: servo-pump studies in the intact canine heart

Circulation

Effects of loading conditions and inotropic state on rapid filling phase of left ventricle

Am J Physiol

Measurement of relaxation in isolated rat ventricular myocardium during hypoxia and reoxygenation

Cardiovasc Res

Load-insensitive relaxation caused by hypoxia in mammalian cardiac muscle

Circ Res

Assessment of Diastolic Function of the Heart: Background and Current Applications of Doppler Echocardiography. Part I. Physiologic and Pathophysiologic Features^*