This Article Full Text Full Text (PDF) CME: Take the course for this article: Circulation: August 7, 2007, Volume 116, Number 6 All Versions of this Article: 116/6/637    most recent CIRCULATIONAHA.106.661983v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kasner, M. Articles by Tschöpe, C. Search for Related Content PubMed PubMed Citation Articles by Kasner, M. Articles by Tschöpe, C. Related Collections Congestive Echocardiography Other diagnostic testing

(Circulation. 2007;116:637-647.)
© 2007 American Heart Association, Inc.

Imaging

Utility of Doppler Echocardiography and Tissue Doppler Imaging in the Estimation of Diastolic Function in Heart Failure With Normal Ejection Fraction

A Comparative Doppler-Conductance Catheterization Study

Mario Kasner, MD, MSc; Dirk Westermann, MD; Paul Steendijk, PhD; Regina Gaub, MD; Ursula Wilkenshoff, MD; Kerstin Weitmann, PhD; Wolfgang Hoffmann, MD, MPH; Wolfgang Poller, MD; Heinz-Peter Schultheiss, MD; Matthias Pauschinger, MD; Carsten Tschöpe, MD

From the Department of Cardiology and Pneumology, Charité–University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany (M.K., D.W., R.G., U.W., W.P., H.-P.S., M.P., C.T.); Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands (P.S.); and Institute for Community Medicine, Ernst-Moritz-Arndt-University of Greifswald, Greifswald, Germany (K.W., W.H.).

Correspondence to Carsten Tschöpe, MD, Department of Cardiology and Pneumology, Charité–University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany. E-mail carsten.tschoepe{at}charite.de

Received August 30, 2006; accepted May 18, 2007.

Background— Various conventional and tissue Doppler echocardiographic indexes were compared with pressure–volume loop analysis to assess their accuracy in detecting left ventricular (LV) diastolic dysfunction in patients with heart failure with normal ejection fraction (HFNEF).

Methods and Results— Diastolic dysfunction was confirmed by pressure–volume loop analysis obtained by conductance catheter in 43 patients (19 men) with HFNEF. Their Doppler indexes were compared with those of 12 control patients without heart failure symptoms and with normal ejection fraction. Invasively measured indexes for diastolic relaxation (, dP/dt_min), LV end-diastolic pressure, and LV end-diastolic pressure–volume relationship (stiffness, b [dP/dV], and stiffness constant, ß) were correlated with several conventional mitral flow and tissue Doppler imaging indexes. Conventional Doppler indexes correlated moderately with the degree of LV relaxation index, (E/A: r=–0.36, P=0.013; isovolumic relaxation time: r=0.31, P=0.040) and b (deceleration time: r=0.39, P=0.012) but not with ß, in contrast to the tissue Doppler imaging indexes E’/A’_lateral (r=–0.37, P=0.008) and E/E’_lateral (r=0.53, P<0.001). Diastolic dysfunction was detected in 70% of the HFNEF patients by mitral flow Doppler but in 81% and 86% by E’/A’_lateral, and E/E’_lateral, respectively.

Conclusions— Of all echocardiographic parameters investigated, the LV filling index E/E’_lateral was identified as the best index to detect diastolic dysfunction in HFNEF in which the diagnosis of diastolic dysfunction was confirmed by conductance catheter analysis. We recommend its use as an essential tool for noninvasive diagnostics of diastolic function in patients with HFNEF.

---

 

CLINICAL PERSPECTIVE

This article has been cited by other articles:

				M. L. Handoko and W. J. Paulus Polishing the diastolic dysfunction measurement stick Eur J Echocardiogr, June 11, 2008; (2008) jen181v1. [Full Text] [PDF]

				W. Zhang and S. J. Kovacs The diastatic pressure-volume relationship is not the same as the end-diastolic pressure-volume relationship Am J Physiol Heart Circ Physiol, June 1, 2008; 294(6): H2750 - H2760. [Abstract] [Full Text] [PDF]

				D. Westermann, M. Kasner, P. Steendijk, F. Spillmann, A. Riad, K. Weitmann, W. Hoffmann, W. Poller, M. Pauschinger, H.-P. Schultheiss, et al. Role of Left Ventricular Stiffness in Heart Failure With Normal Ejection Fraction Circulation, April 22, 2008; 117(16): 2051 - 2060. [Abstract] [Full Text] [PDF]

				A. E. Weyman The Year in Echocardiography J. Am. Coll. Cardiol., March 25, 2008; 51(12): 1221 - 1229. [Full Text] [PDF]

				S. Masutani, W. C. Little, H. Hasegawa, H.-J. Cheng, and C.-P. Cheng Restrictive Left Ventricular Filling Pattern Does Not Result From Increased Left Atrial Pressure Alone Circulation, March 25, 2008; 117(12): 1550 - 1554. [Abstract] [Full Text] [PDF]

				M. M. Riordan, E. P. Weiss, T. E. Meyer, A. A. Ehsani, S. B. Racette, D. T. Villareal, L. Fontana, J. O. Holloszy, and S. J. Kovacs The effects of caloric restriction- and exercise-induced weight loss on left ventricular diastolic function Am J Physiol Heart Circ Physiol, March 1, 2008; 294(3): H1174 - H1182. [Abstract] [Full Text] [PDF]

				O. W. Nielsen, L. Kober, and C. Torp-Pedersen Heart failure with preserved ejection fraction: dangerous, elusive, and difficult Eur. Heart J., February 1, 2008; 29(3): 285 - 287. [Full Text] [PDF]

				W.H. W. Tang and G. S. Francis The Year in Heart Failure J. Am. Coll. Cardiol., December 11, 2007; 50(24): 2344 - 2351. [Full Text] [PDF]

				W. H. Gaasch and W. C. Little Assessment of Left Ventricular Diastolic Function and Recognition of Diastolic Heart Failure Circulation, August 7, 2007; 116(6): 591 - 593. [Full Text] [PDF]