Unlocking the Mysteries of Diastolic FunctionDeciphering 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.
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Figure 1 Biplane Methods With Which to Calculate LA Volume
(A) Biplane area length, A1 = left atrial (LA) area, 4-chamber view; A2 = LA area, 2-chamber view; L1 and L2: length from midplane of mitral annulus to superior LA, L = LA length, L1 or L2 whichever is shorter; (B) Biplane Simpson’s where the volume of the LA is calculated as the sum of the volume of each individual disc.
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Figure 2 The Natural History of Diastolic Function and LV Filling
DD = diastolic function; e' = early diastolic mitral annular velocity; LAP = left atrial pressure; LV = left ventricular.
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Figure 4 Transmitral Doppler and Tissue Doppler of the Mitral Annulus
(A) Normal left ventricular filling pressure. (Left) Mitral inflow velocity profile; (right) septal annular tissue velocity profile. (B) Elevated left ventricular filling pressure. e' = early diastolic mitral annular velocity; other abbreviations as in Figure 3.
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Figure 5 Global Strain Rate Profile
Global strain rate (SR) signal (purple, right axis), and mitral velocity (left axis) tracings by color tissue Doppler from the septal (blue) and lateral side (red) of the mitral annulus from the same cardiac cycle. Note the SR signal during the isovolumic relaxation phase of the cardiac cycle (*) and the corresponding velocity tracings from the mitral annulus recording during the same interval. Aa = late diastolic velocity; AVC = aortic valve closure; Ea = mitral annulus early diastolic velocity; GSRa = global strain rate during late left ventricular filling; GSRe = global strain rate during early left ventricular filling; GSRivr = global strain rate during the isovolumic relaxation phase of the cardiac cycle period; MVO = mitral valve opening. Reprinted, with permission, from Wang et al. (32).
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Figure 8 VVI Illustrating the Rotation Motion of the LV Apex
(Left) Systole where the apical rotation is predominantly anticlockwise; (right) systole where the apical rotation (now untwisting) is predominantly in the clockwise direction. LV = left ventricular; VVI = Velocity Vector Image.
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