Assessment of diastolic function

Modern assessment of left ventricular (LV) diastolic function should be based on the estimation of degree of LV filling pressure (LVFP), which is the true determinant of symptoms/signs and prognosis in heart failure.In order to achieve this goal, standard Doppler assessment of mitral inflow pattern (E/A ratio, deceleration time, isovolumic relaxation time) should be combined with additional manoeuvres and/or ultrasound tools such as: ◆ Valsalva manoeuvre applied to mitral inflow pattern. ◆ Pulmonary venous flow pattern. ◆ Velocity flow propagation by colour M-mode. ◆ Pulsed wave tissue Doppler of mitral annuls (average of septal and lateral E′ velocity).In intermediate doubtful situations, the two-dimensional determination of left atrial (LA) volume can be diagnostic, since LA enlargement is associated with a chronic increase of LVFP in the absence of mitral valve disease and atrial fibrillation.Some new echocardiographic technologies, such as the speckle tracking-derived LV longitudinal strain and LV torsion, LA strain, and even the three-dimensional determination of LA volumes can be potentially useful to add further information. In particular, the reduction of LV longitudinal strain in patients with LV diastolic dysfunction and normal ejection fraction demonstrates that a subclinical impairment of LV systolic function already exists under these circumstances.