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J Am Coll Cardiol, 1998; 32:865-875
© 1998 by the American College of Cardiology Foundation
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REVIEW ARTICLES

New Doppler echocardiographic applications for the study of diastolic function

Mario J. Garcia, MD, FACCa, James D. Thomas, MD, FACCa and Allan L. Klein, MD, FACCa

a Cardiovascular Imaging Center, Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA

Manuscript received April 7, 1998; revised manuscript received June 9, 1998, accepted June 17, 1998.

Address for correspondence: Dr. Mario J. Garcia, Desk F-15, Division of Cardiology, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195
garciam{at}cesmtp.ccf.org

Doppler echocardiography is one of the most useful clinical tools for the assessment of left ventricular (LV) diastolic function. Doppler indices of LV filling and pulmonary venous (PV) flow are used not only for diagnostic purposes but also for establishing prognosis and evaluating the effect of therapeutic interventions. The utility of these indices is limited, however, by the confounding effects of different physiologic variables such as LV relaxation, compliance and filling pressure. Since alterations in these variables result in changes in Doppler indices of opposite direction, it is often difficult to determine the status of a given variable when a specific Doppler filling pattern is observed. Recently, color M-mode and tissue Doppler have provided useful insights in the study of diastolic function. These new Doppler applications have been shown to provide an accurate estimate of LV relaxation and appear to be relatively insensitive to the effects of preload compensation. This review will focus on the complementary role of color M-mode and tissue Doppler echocardiography and traditional Doppler indices of LV filling and PV flow in the assessment of diastolic function.

Abbreviations and Acronyms
  Am = peak diastolic myocardial velocity during atrial contraction
  AR = peak pulmonary venous atrial reversal velocity
  D = peak diastolic pulmonary venous flow velocity
  DT = early filling deceleration time
  E = peak early transmitral flow velocity
  Em = peak early diastolic myocardial velocity
  IVRT = isovolumic relaxation time
  LA = left atrial
  LV = left ventricular
  PV = pulmonary vein
  S = peak systolic pulmonary venous flow
  Sm = peak systolic myocardial velocity
  {tau} = time constant of isovolumic relaxation
  TD = color M-mode time delay to apical filling
  TDE = tissue Doppler echocardiography
  Vp = color M-mode flow propagation velocity




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