Assessment of left ventricular diastolic events interrelations: an integrated approach

Background: Left ventricular (LV) diastolic function represents a complex performance that involves long axis displacement, myocardial lengthening velocities as well as cavity filling. The aim of this study was to assess the various diastolic event interrelations in a group of patients with different degrees of diastolic dysfunction. Methods: 128 consecutive subjects with various degrees of diastolic impairment were studied by Doppler echocardiography. The amplitude of early diastolic (El) and late diastolic (Al) long axis lengthening was measured by M-mode and corresponding myocardial velocities (Ea and Aa) by Tissue Doppler. LV filling velocities were also acquired by spectral pulsed wave Doppler. Results: Early diastolic long axis amplitudes and velocities correlated (r = 0.73, P < 0.0001) as did late diastolic ones (r = 0.67, P < 0.0001). El of ≤ 5.6 mm was 80.6% sensitive and 70.5% specific in predicting Ea of < 8.0 cm/s, a feature of LV impaired relaxation. El/Al correlated with Ea/Aa (r = 0.78, P < 0.0001), as did E/El with E/Ea ratios (r = 0.74, P < 0.0001). An E/El ratio > 17.3 cm/s/mm had 94.1% sensitivity and 87.4% specificity for predicting an E/Ea ratio > 15, a marker for raised LV filling pressures. El ≤ 6.8 mm, total amplitude of diastolic motion (El + Al) ≤ 11.5 mm, and E/El > 14.2 cm/s/mm were the best criteria to discriminate between normal diastolic function and pseudonormal/restrictive LV filling. Conclusion: Diastolic LV components of motion, amplitude and velocities are not independent, neither from each other nor from filling pressures. An integrated approach towards using them all in assessing diastolic function, particularly in patients with raised filling pressure should be of great clinical value.