Practical diastology

Abstract

Left ventricular (LV) diastolic dysfunction is being recognized as an important part in the pre-operative evaluation. Pre-operative LV diastolic dysfunction has been associated with increased risk of post-operative complications. Furthermore guidelines have been published on the assessment of LV diastolic function. However LV diastolic function is significantly influenced by loading conditions which are typically altered during cardiac and non-cardiac surgery. In addition, waveform analysis from the pulmonary artery catheter tend to correlate with diastolic function and loading conditions. The advantage of hemodynamic monitoring being that they are continuously displayed as opposed to intermittent diastolic parameters. Finally if the importance of diastolic function assessment is to estimate filling pressure, the presence of B lines with the use of lung ultrasound is a simpler method in detecting pulmonary edema. Another indirect evidence of either LV systolic or diastolic dysfunction is an abnormal near-infrared spectroscopy value. Finally it might be more important to evaluate right ventricular (RV) diastolic dysfunction as RV dysfunction is significantly associated with pulmonary hypertension and consequently mortality. Such assessment of RV diastolic dysfunction can be obtained continuously with the use of RV pressure waveform monitoring.

Keywords: Diastolic function, Left ventricle, Right ventricle, Lung ultrasound, Pressure waveform

Core tip: Diastology is mainly thought as the evaluation of left ventricular (LV) diastolic function. However evaluation of right ventricular (RV) diastolic function might be as relevant. Furthermore pressure waveform analysis are influence by filling pressure and therefore might represent another method to continuously assess both LV and RV diastolic function. This is true particularly for RV pressure waveform analysis which correlate with RV diastolic function. Finally as the end-point of diastology is to provide information on cardiac function and filling pressure, the use of near-infrared spectroscopy and lung ultrasound might be the simplest way to evaluate the impact of diastolic dysfunction.