Evaluation of the Patient with Diastolic Dysfunction

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3 Evaluation of the Patient with Diastolic Dysfunction

Restrictive Cardiomyopathy

Storage Endomyocardium

TABLE 3-2 OVERALL ECHOCARDIOGRAPHIC APPROACH FOR ASSESSING DIASTOLIC DYSFUNCTION

Modality View/Technique Findings
2D Apical, parasternal, subcostal
Pulsed wave Doppler 4-chamber: Ultrasound beam aimed at an angle of 20 degrees laterally to apex, and the sample volume between the tips of the mitral valve leaflets
Suprasternal short-axis
Subcostal
Tissue Doppler imaging 4-Chamber: 2-mm sample volume at the medial mitral annulus with the Doppler beam parallel to the longitudinal movement. Gain settings and wall filters should be low and velocity scale expanded. Varying E, E/E patterns (see text for details)

TABLE 3-3 Approaches and Findings in RCM

Modality General Findings Specific Findings
Chest radiograph Normal-sized heart.
Dilated atria.
Signs of pulmonary congestion or interstitial edema.
Pleural effusion may occur.
Mediastinal lymphadenopathy; pulmonary parenchymal disease in sarcoidosis.
Electrocardiogram Nonspecific ST- and T-wave abnormalities.
Conduction abnormalities.
Same chamber and wall dimensions and functions as in echocardiography.
Low voltage in precordial leads is seen in ~50% of patients with amyloidosis with cardiac involvement.
Pseudo-infarct pattern (QS wave in consecutive leads) is seen in ~50% of patients with cardiac amyloidosis.
Fibrosis caused by cardiac sarcoidosis can be detected with late gadolinium enhancement.
Trilaminar appearance (normal myocardium, thickened fibrotic endocardium, and overlying thrombus) may be detectable in endomyocardial diseases.
Global reduction in T2* cardiac tissue is commonly seen in hemochromatosis.
CT Same chamber and wall dimensions and functions as in echocardiography.  
Biposy In most cases nonspecific. Apple-green birefringence, electron microscopy findings in amyloidosis.
Radionuclide imaging Mainly nonspecific findings in RCM. With increased cardiac involvement in amyloidosis, Tc-99m labeled tracers are detectable.
Cardiac catheterization Nonspecific findings of diastolic dysfunction (increased diastolic pressures, right-sided square root sign, and often LVEDP ≥5 mm Hg greater than RVEDP).  

LVEDP, LV end-diastolic pressure; RVEDP, RV end-diastolic pressure; Tc-99m, 99-mtechnetium.

Specific Diagnoses

Physiologic Data

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