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STATE-OF-THE-ART PAPER

Unlocking the Mysteries of Diastolic Function

Deciphering the Rosetta Stone 10 Years Later

Steven J. Lester, MD, FACC, FRCPC, FASE^_*,_*, A. Jamil Tajik, MD, FACC^_*, Rick A. Nishimura, MD, FACC, Jae K. Oh, MD, Bijoy K. Khandheria, MBBS, FACC, FASE, FESC^_* and James B. Seward, MD, FACC

^_* Division of Cardiovascular Disease, Mayo Clinic, Scottsdale, Arizona
Mayo Clinic, Rochester, Minnesota.

Manuscript received August 9, 2007; revised manuscript received September 20, 2007, accepted September 24, 2007.

^_* Reprint requests and correspondence: Dr. Steven J. Lester, Cardiovascular Diseases, Mayo Clinic Arizona, 13400 East Shea Boulevard, Scottsdale, Arizona 85259. (Email: lester.steven{at}mayo.edu).

It has now been a quarter of a century since the first description by Kitabatake and his associates of the use of echo-Doppler to characterize the transmitral flow velocity curves in various disease states. A decade ago we described the role of echocardiography in the "Evaluation of Diastolic Filling of Left Ventricle in Health and Disease: Doppler Echocardiography Is the Clinician’s Rosetta Stone." Over the ensuing decade, advances in echo-Doppler have helped to further decipher the morphologic and physiological expression of cardiovascular disease and unlock additional mysteries of diastology. The purpose of this review is to highlight the developments in echo-Doppler and refinements in our knowledge that have occurred over the past decade that enhance our understanding of diastology.

Abbreviations and Acronyms   A = A velocity   ACEI = angiotensin-converting enzyme inhibitor   ARA = aldosterone receptor antagonist   ARB = angiotensin I receptor antagonist   DT = deceleration time   DTI = Doppler tissue imaging   E = E velocity   Ea = arterial elastance   IVRT = isovolumic relaxation time   LA = left atrium   LV = left ventricle/ventricular   LVOT = left ventricular outflow tract   SRivr = strain rate during the isovolumic relaxation phase of the cardiac cycle   Vp = mitral inflow propagation velocity

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