Valvular Disease

Pericardial Disease

Myocardial Disease

Congenital Disease


Left Ventricular Diastolic Function

To evaluate left ventricular diastolic function, a PW Doppler sample volume is placed at the mitral valve leaflet tips and the following measurements recorded:

Abnormal Function

Three patterns or stages indicate abnormal diastolic filling

Stage I : Impaired early left ventricular relaxation

The stage I filling pattern represents impaired (slow) early left ventricular relaxation. At this point, the patient is usually asymptomatic, with normal filling pressures.

Stage II: Pseudonormalization

At stage II, the effects of impaired (slow) early left ventricular relaxation on early diastolic filling become opposed by the elevated left atrial pressure, and the early diastolic transmitral pressure gradient and mitral flow velocity pattern return to normal. This phenomenon is called pseudonormalization to indicate that although left ventricular filling appears normal significant abnormalities of diastolic function are present. In most patients, left atrial and left ventricular end-diastolic filling pressures are elevated, the left atrium is increased in size, and patients often complain of exertional dyspnea. Stage II suggests a decrease in left ventricular compliance, especially when there is a large pulmonary vein "a" wave flow reversal.

Stage III: "Restricted" Filling Pattern

Stage III represents a severe decrease in left ventricular chamber compliance. Diastolic filling pressures are elevated and patients markedly symptomatic and demonstrate a severely reduced functional capacity. The left atrium is dilated and hypocontractile. Despite the presence of impaired left ventricular relaxation, the markedly elevated left atrial pressure results in a high velocity of early diastolic filling, which stops abruptly because of an abnormally rapid rise in ventricular pressure and atrial dysfunction.



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