of Diastolic Function Harvard University左室舒张功能的评价哈佛大学课件.ppt

Echocardiographic Evaluation of LV Diastolic Function Natalie Bello, M.D. October 14, 2009 Objectives Defining Diastole Diastolic Function Measurements Diastolic Function Grades Diastology: The science and art of characterizing left ventricular relaxation, filling dynamics, and their integration into clinical practice. Objectives Defining Diastole Diastolic Function Measurements Diastolic Function Grades IVRT Tissue Doppler Imaging (e’) E/e’ ratio (combo of transmitral flow velocity and annular velocity) is best parameter for predicting mean LVEDP (8 nl, 15 abnl); but cannot be used in isolation! Global Strain Rate (SRivr) LA Volume Barometer of the chronicity of diastolic dysfunction. LA volume correlates with risk of cardiovascular events including MI, CVA, A fib and CHF. More stable than LV filling pressures. Objectives Defining Diastole Diastolic Function Measurements Diastolic Function Grades Approach to the Patient Summary Diastole is a complex, energy dependent process. Echo indices of diastolic fn include: Transmitral Doppler inflow Tissue Doppler velocities Pulmonary venous Doppler flow Color M-mode propagation velocity Diastolic dysfunction is a measurable, step-wise progression from normal to irreversible. References Otto CM. Textbook of clinical echocardiography, 4th Edition. Douglas PS. The left atrium: a biomarker of chronic diastolic dysfunction and relation to cardiovascular risk burden. JACC 2002;40:1206-7. http://www.echobasics.de/diastole-en.html Lester SJ, Tajik AJ, Nishimura RA, et al. Unlocking the mysteries of diastolic function. JACC 2008;51:679-89. Nagueh SF, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am S Echo 2009;22:107-33 Nishimura RA, Tajik AJ. Evaluation of diastolic filling of left ventricle in health and disease: Doppler echocardiography is the clinician’s Rosetta Stone. JACC 1997;30:8-18. Ommen SR, Nishimura RA, Appleton CP, et al. Clinical utility of Dopple