Author + information
- Sheldon E. Litwin, MD∗ ( and )
- Michael R. Zile, MD
- Department of Internal Medicine, Division of Cardiology, Medical University of South Carolina and the Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South CarolinaMedical University of South Carolina and the Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina
- ↵∗Address for correspondence:
Dr. Sheldon E. Litwin, Medical University of South Carolina, 30 Courtenay Drive, Charleston, South Carolina 29425.
• Diastolic function is difficult to define and to quantify, but diastolic abnormalities contribute to elevated ventricular filling pressures, the main cause of symptoms in heart failure.
• Assessment of diastolic function may help in diagnosing heart failure, particularly with normal ejection fraction, as well as in determining prognosis and helping to guide treatment.
• Echocardiography and measurement of serum natriuretic peptide levels are the most commonly used methods of assessing diastolic function. Both approaches are limited by offering only indirect information about ventricular filling pressures, and neither has yet been shown to provide benefit in guiding heart failure therapy.
• Continuous, direct measurement of left ventricular filling pressures using implanted pressure sensors has shown promise in guiding chronic heart failure therapy and reducing heart failure-related events.
• There is a need for additional optimization of methods for assessing cardiac filling pressures including the type of devices used, combinations of measurements, streamlining work flow, and tailoring therapeutic interventions based on the various readouts.
Symptoms of heart failure (HF) are due in large part to elevation of left and/or right ventricular filling pressures. Although abnormal diastolic function is difficult to define, it contributes to the elevation of filling pressures. Tests that characterize aspects of diastolic function or structural changes associated with diastolic dysfunction, may help in establishing a diagnosis of HF, assessing prognosis, and guiding treatments. Individual echocardiographic parameters correlate weakly with LV (LV) filling pressures measured directly. However, a combination of multiple parameters improves accuracy for detection of elevated filling pressures. Serum natriuretic peptide levels are related to ventricular filling pressures and, when elevated, are a key diagnostic criterion for HF. Currently available evidence is not adequate to recommend serial echocardiographic studies or natriuretic peptide level measurements to assess changes in filling pressures or to guide HF therapy. Measurements of inferior vena cava size and dynamics have potential for identifying inadequate decongestion during episodes of acute decompensated HF but have not yet demonstrated utility in improving HF outcomes. Direct measurement of LV filling pressures using implanted pressure sensors is the only “diastolic assessment” thus far that has proven efficacy in reducing HF hospitalization rates.
Both authors have reported that they have no relationships relevant to the contents of this paper to disclose. Sherif Nagueh, MD, served as Guest Editor for this paper.
- Received October 28, 2018.
- Revision received February 14, 2019.
- Accepted February 20, 2019.
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.