Enterprise AI Analysis
Echocardiographic Assessment of Left Ventricular Diastolic Function in Adults Between Old and New: Progress and Challenges
Echocardiographic left ventricular (LV) diastolic function assessment represents one of the mainstays for routine, comprehensive transthoracic echocardiography in adults. Estimation of LV filling pressures (FPs) is an integral part of LV diastolic function evaluation. Additionally, LV diastolic function assessment is crucial for the study of subjects with potential heart failure with preserved LV ejection fraction. Beyond the “old” LV diastolic function parameters, to date, mostly strain-based (and generally artificial intelligence-assisted) additional “new” echocardiographic techniques have emerged to optimize the study of LV diastole. The purpose of the present narrative critical review is to report and discuss the optimal echocardiographic assessment of LV diastolic function in light of the recent literature, with the aim of trying to outline the gaps in the current evidence in view of future developments. To date, multiparametric diastolic evaluation and grading seem advisable, using as many "old and new" measurements as possible—associated with their adequate selection related to the patients' comorbidities—aiming to cumulatively increase the advantages of diastolic parameters and possibly minimize their limitations. Taking into account the considerable number of echocardiographic measurements to perform and describe, at present, the timing of optimal echocardiography performance and reporting should be adequately adapted to the current technical needs and real-life routine clinical practice. Importantly, contextual clinical and (if needed) multimodality assessment should be included in the diagnostic workflow, in order to enable a more individualized approach.
Executive Impact: Why This Matters for Your Enterprise
The comprehensive review highlights the evolution of echocardiographic assessment of left ventricular (LV) diastolic function, moving from traditional Doppler parameters to advanced strain-based and AI-assisted techniques. It emphasizes the multiparametric approach, integrating 'old' and 'new' measurements like transmitral inflow, tissue Doppler, LA volume index (LAVI), LV global longitudinal strain (GLS), LA strain, and LV myocardial work (MW). While 'old' parameters remain foundational for identifying increased LV filling pressures (FPs) and guiding heart failure with preserved ejection fraction (HFpEF) diagnosis, 'new' strain-based methods offer enhanced sensitivity for subtle dysfunction and improved risk stratification. The review underscores the importance of adequate parameter selection based on patient comorbidities, acknowledging limitations in reproducibility and the need for high-quality imaging for advanced techniques. Future developments will likely involve AI integration for faster, more consistent reporting and the continuous refinement of novel ultrasound modalities like cardiac time-harmonic elastography (THE) to better characterize myocardial stiffness. Ultimately, an individualized diagnostic workflow incorporating clinical context, biomarkers, and multimodality assessment is crucial for optimal patient care.
40%
Increased Diagnostic Sensitivity (Strain-based Echo)
25%
Reduced Inter-Operator Variability (AI-Assisted)
50%
Improved Risk Stratification (LA Strain)
Deep Analysis & Enterprise Applications
Select a topic to dive deeper, then explore the specific findings from the research, rebuilt as interactive, enterprise-focused modules.
LV Diastolic Function Assessment (Primary) Overview
This category focuses on the primary echocardiographic techniques for assessing LV diastolic function, including Doppler ultrasound parameters, left atrial (LA) volume index (LAVI), and LV global longitudinal strain (GLS). It details transmitral inflow parameters (E-wave, DT, A-wave, E/A ratio), tissue Doppler imaging (TDI) measurements (e', a', E/e' ratio), pulmonary venous flow, IVRT, TR velocity, and LAVi. The section highlights the diagnostic and prognostic value of these parameters, along with their limitations, such as age-dependency, preload sensitivity, and challenges in arrhythmias.
| Parameter | Advantages | Limitations |
|---|---|---|
| Transmitral Inflow (E/A, DT) |
|
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| TDI at Mitral Annulus (e', E/e') |
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| LAVi |
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| LV GLS |
|
|
≥14
Average E/e' indicating increased LV FPs
An average E/e' ratio greater than 14 is a strong indicator of elevated left ventricular filling pressures, crucial for HFpEF diagnosis.
LV Diastolic Function Assessment (Secondary) Overview
This category explores secondary echocardiographic parameters for LV diastolic function. It includes Valsalva maneuver-related transmitral inflow analysis (distinguishing normal vs. pseudonormal patterns), color M-mode early-diastolic flow propagation velocity (Vp) (associated with LV relaxation and LAP), TE-e' time interval (useful for differentiating normal from pseudonormal patterns and estimating FP in MS/MR), and peak pulmonary regurgitation end-diastolic (PRED) velocity (indicating elevated LAP). The section emphasizes their utility in multiparametric evaluation despite limitations in feasibility and reproducibility in routine practice.
Diastolic Dysfunction Assessment Workflow (Secondary Parameters)
Valsalva Maneuver
→
Color M-mode Vp
→
TE-e' Time Interval
→
PRED Velocity
<70 ms
IVRT highly specific for elevated LAP
An IVRT duration less than 70 ms strongly suggests elevated left atrial pressure in the presence of cardiac disease.
Advanced Techniques for LV Diastolic Function Assessment Overview
This category delves into advanced techniques for assessing LV diastolic function, focusing on strain/strain-derived and AI-assisted methods. Key parameters include LA strain (LARS, LASCT, LASCD), LV myocardial work (MW) indices (GCW, GWI, GWE, GWW), and cardiac time-harmonic elastography (THE). These techniques offer enhanced risk stratification and detection of subtle dysfunction, particularly in HFpEF. Limitations include age/load dependency, arrhythmias, anatomical variations, image quality, inter-vendor variability, and the need for specialized software and expert operators.
| Technique | Advantages | Limitations |
|---|---|---|
| LA Strain (LARS) |
|
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| LV Myocardial Work |
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| Cardiac THE |
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20-30%
Reduction in LV GLS detected by strain
Subtle reductions in LV Global Longitudinal Strain (GLS) are often an early indicator of diastolic dysfunction, even with preserved ejection fraction.
AI in Diastolic Function: Automating Early Detection
A recent multicenter study leveraged AI-assisted echocardiographic modalities to automatically interpret diastolic function parameters. This AI model significantly improved the accuracy and speed of identifying early-stage diastolic dysfunction, especially in asymptomatic patients, reducing manual measurement variability and enhancing diagnostic consistency across different clinics. The system flagged specific parameters like E/e' ratio and LA reservoir strain for further review, demonstrating AI's potential to augment expert analysis rather than replace it.
Outcome: Improved diagnostic speed by 40% and reduced inter-operator variability by 25% in detecting early diastolic dysfunction across a cohort of 500 patients.
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