Navigating Diastolic Dysfunction
Diastolic dysfunction, though often overshadowed by its systolic counterpart, plays a pivotal role in heart failure and has become a focus of growing clinical attention. This condition refers to the heart’s impaired ability to relax and fill during diastole, leading to elevated pressures within the left ventricle (LV) and, ultimately, the left atrium (LA). It doesn’t take a reduction in ejection fraction for a heart to fail—diastolic dysfunction can progress silently for years, culminating in diastolic heart failure, a condition marked by breathlessness, fatigue, fluid overload, and fluid buildup in the lungs, abdomen, and legs. This is one of the leading causes of heart failure hospitalizations and an accurate assessment of diastology with echo is key.
Echocardiography is the gold standard for this assessment, offering a real-time evaluation of hemodynamics. While diastolic dysfunction may seem complex, this article will explore the specific echocardiographic measurements needed, following the American Society of Echocardiography recommendations for proper assessment and grading.
The essential measurements required for the evaluation of diastolic dysfunction include:
Average E/e'
Septal e' velocity and Lateral e' velocity
Tricuspid regurgitation (TR) velocity
Left atrial (LA) volume index
E/A ratio
Peak E velocity
In cases of diastolic dysfunction, the heart has trouble relaxing and filling properly during diastole. Ventricular compliance also plays a role in these cases; when the ventricle stiffens, it cannot stretch to accommodate blood as easily. As a result, higher pressures are needed to fill the heart, leading to elevated filling pressures. This can cause congestion in the lungs or lower extremities and blood backs up due to the heart’s inability to fill. This chronic process of ventricular stiffening is the hallmark of diastolic dysfunction and often associated with hypertension and aging.
