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Diastolic dysfunction represents a combination of impaired left ventricular (LV) relaxation, restoration forces, myocyte lengthening load, and atrial function, culminating in increased LV filling pressures. Current Doppler echocardiography guidelines recommend using early to late diastolic transmitral flow velocity (E/A) to assess diastolic function, and E to early diastolic mitral annular tissue velocity (E/e') to estimate LV filling pressures. Although both parameters have important diagnostic and prognostic implications, they should be interpreted in the context of a patient's age and the rest of the echocardiogram to describe diastolic function and guide patient management. This review discusses: 1) the physiological basis for the E/A and E/e' ratios; 2) their roles in diagnosing diastolic dysfunction; 3) prognostic implications of abnormalities in E/A and E/e'; 4) special scenarios of the E/A and E/e' ratios that are either useful or challenging when evaluating diastolic function clinically; and 5) their usefulness in guiding therapeutic decision making.

ObjectivesWe sought to examine the accuracy/consistency of a novel ultrasound speckle tracking imaging (STI) method for left ventricular torsion (LVtor) measurement in comparison with tagged magnetic resonance imaging (MRI) (a time-domain method similar to STI) and Doppler tissue imaging (DTI) (a velocity-based approach).BackgroundLeft ventricular torsion from helically oriented myofibers is a key parameter of cardiac performance but is difficult to measure. Ultrasound STI is potentially suitable for measurement of angular motion because of its angle-independence.MethodsWe acquired basal and apical short-axis left ventricular (LV) images in 15 patients to estimate LVtor by STI and compare it with tagged MRI and DTI. Left ventricular torsion was defined as the net difference of LV rotation at the basal and apical planes. For the STI analysis, we used high-frame (104 ± 12 frames/s) second harmonic two-dimensional images.ResultsData on 13 of 15 patients were usable for STI analysis, and LVtor profile estimated by STI strongly correlated with those by tagged MRI (y = 0.95x + 0.19, r = 0.93, p < 0.0001, analyzed by repeated-measures regression models). The STI torsional velocity profile also correlated well with that by the DTI method (y = 0.79x + 2.4, r = 0.76, p < 0.0001, by repeated-measures regression models) with acceptable bias.ConclusionsThe STI estimation of LVtor is concordant with those analyzed by tagged MRI (data derived from tissue displacement) and also showed good agreement with those by DTI (data derived from tissue velocity). Ultrasound STI is a promising new method to assess LV torsional deformation and may make the assessment more available in clinical and research cardiology.

Both tricuspid annular peak systolic excursion (TAPSE) and tricuspid lateral annular systolic velocity (S') are recommended for the evaluation of right ventricular (RV) systolic performance, despite being confounded by tricuspid regurgitation (TR). The usefulness of RV free wall longitudinal strain

Background: Exercise training (ExT) improves functional capacity in systolic heartfailure, but the role of ExT in diastolic dysfunction patients (DD) is unclear.Methods:Twenty four DD patients were randomized to ExT or normal treatment. ExT wascompleted in 15 patients (8 men, 63±4 years, LVEF 55±9%) 9 DD patients undertookusual treatment (7 men, 58±8 years, LVEF 57±7%). Peak VO2, quality of life QOL;Minnesota Living with Heart Failure [MLWHF] and Hare-Davis [HD] questionnaires) andecho measures (EF, systolic [Sm] and diastolic tissue velocity [Em] and filling pressure[E/E’]) were performed at baseline and 16 weeks ExT.Results:Both groups showed similar baseline VO2 (13.2±5.8 vs 16.4±4.2 mls/kg/min,p=0.16), Sm (5.2±1.2 vs 6.0±0.9 cm/s, p=0.10) and E/E’ (21.6±12 vs 11.2±10, p=0.12)but different Em (3.7±3.8 cm/s vs 6.6±1.6, p=0.04). Baseline MLWHF and HD scoreswere similar in both groups. After ExT, the increment in peak VO2 was significantly greaterin ExT (27%) versus control group (3%, p=0.02). Increment in peak VO2 was predicted bybaseline E and A wave velocity (r =0.87, p