Weidemann F, Niemann M, Herrmann S, Ertl G, Störk S
Comprehensive Heart Failure Center Würzburg, Medizinische Klinik und Poliklinik I, Universitätsklinik Würzburg, Oberdürrbacherstrasse 6, Würzburg, Germany.
Herz. 2013 Feb;38(1):18-25. doi: 10.1007/s00059-012-3751-5.
Diastolic heart failure, also known as heart failure with preserved left ventricular ejection fraction (HF-pEF), is responsible for approximately 50 % of all heart failure cases. According to current guidelines the diagnosis HF-pEF requires three criteria: (1) signs or symptoms of heart failure, (2) presence of a normal left ventricular ejection fraction and (3) evidence of diastolic dysfunction. Echocardiography is the diagnostic modality of choice, especially after ruling out other causes of dyspnea, such as pulmonary diseases, heart rhythm disturbances and volume overload. Important echocardiographic parameters for the assessment of diastolic function are atrial dimensions, myocardial mass, mitral inflow pattern, pulmonary vein flow, propagation velocity of mitral inflow and the tissue Doppler of the mitral annulus. Nevertheless, a complete echocardiographic examination should be performed in every patient with heart failure. In general, diastolic dysfunction is frequently associated with increased atrial diameter and left ventricular hypertrophy. In advanced stages pulmonary hypertension can be present. A robust method for evaluation of systolic function in patients with diastolic dysfunction is crucial. The mitral inflow pattern provides various parameters to describe diastolic function (E/A ratio, deceleration time, isovolumetric relaxation time). In case of difficulties to separate a normal from a pseudonormal mitral inflow pattern the Valsalva maneuver can be used. Another valuable parameter for this differentiation is the duration of the backward flow in the pulmonary veins in contrast to forward flow over the mitral valve. Tachycardia or atrial fibrillation is a major problem for grading of diastolic function; however, in patients with atrial fibrillation E/e' is a well-established parameter. In summary, this review provides a detailed overview and discussion of the established and newer echocardiography techniques for the evaluation of diastolic function and provides an algorithm for the assessment of diastolic dysfunction in everyday routine.
舒张性心力衰竭，也称为射血分数保留的心力衰竭（HF-pEF），约占所有心力衰竭病例的50%。根据现行指南，HF-pEF的诊断需要三个标准：（1）心力衰竭的体征或症状，（2）左心室射血分数正常，（3）舒张功能障碍的证据。超声心动图是首选的诊断方法，尤其是在排除其他导致呼吸困难的原因后，如肺部疾病、心律失常和容量超负荷。评估舒张功能的重要超声心动图参数包括心房大小、心肌质量、二尖瓣血流模式、肺静脉血流、二尖瓣血流传播速度和二尖瓣环组织多普勒。然而，每一位心力衰竭患者都应进行完整的超声心动图检查。一般来说，舒张功能障碍常与心房直径增加和左心室肥厚有关。在晚期可能会出现肺动脉高压。一种评估舒张功能障碍患者收缩功能的可靠方法至关重要。二尖瓣血流模式提供了各种描述舒张功能的参数（E/A比值、减速时间、等容舒张时间）。如果难以区分正常与假性正常二尖瓣血流模式，可采用瓦尔萨尔瓦动作。另一个用于这种区分的有价值参数是肺静脉逆流持续时间与二尖瓣正向血流持续时间的对比。心动过速或心房颤动是舒张功能分级的主要问题；然而，在心房颤动患者中，E/e'是一个成熟的参数。总之，本综述详细概述并讨论了用于评估舒张功能的既定和更新的超声心动图技术，并提供了日常评估舒张功能障碍的算法。
