Diastolic Dysfunction and Cardiac Failure in the Intensive Care Unit

  • J. Poelaert
  • E. Osipowska
  • C. Verborgh
Conference paper


With the advent of newer technology, recognition of diastolic dysfunction has become a major feature of cardiac disease, in heart failure as in septic shock. Doppler echocardiography plays a pivotal role in the evaluation of both systolic and diastolic function. Preserved systolic function, in conjunction with diastolic dysfunction, is an early sign of cardiac failure. Therefore, early diagnosis of diastolic failure is warranted. In recent years, measurement of intra-myocardial tissue Doppler velocities and deformations of the myocardial wall have attracted the attention of many researchers. In this chapter, the most recent echocardiographic and Doppler applications, based on wave progression, pressure gradients, mitral valve leaflet and annular motion, and ventricular rotation will be discussed to give the critical care specialist a better insight into the diagnosis of diastolic dysfunction.


Mitral Valve Diastolic Dysfunction Diastolic Function Tissue Doppler Imaging Doppler Echocardiography 


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  1. 1.
    Brutsaert DL, Rademakers FE, Sys SU, Gillebert TC, Housmans PR (1985) Analysis of relaxation in the evaluation of ventricular function of the heart. Prog Cardiovasc Dis 28:143–163PubMedCrossRefGoogle Scholar
  2. 2.
    Brutsaert DL, Rademakers FE, Sys SU, Gillebert TC, Housmans PR (1984) The heart as an integrated muscle and pump system: triple control and subdivision of the cardiac cycle. Acta Cardiol 39:89–95PubMedGoogle Scholar
  3. 3.
    Gillebert T, Leite-Moreira A, De Hert S (1997) The hemodynamic manifestation of normal myocardial relaxation. A framework for experimental and clinical evaluation. Acta Cardiologica 52:223–246PubMedGoogle Scholar
  4. 4.
    De Hert S, Gillebert T, Ten Broecke P, Mertens E, Rodrigus I, Moulijn A (1999) Contractionrelaxation coupling and impaired left ventricular performance in coronary surgery patients. Anesthesiology 90:748–757Google Scholar
  5. 5.
    Ishizaka S, Asanoi H, Wada O, Kameyama T, Inoue H (1995) Loading sequence plays an important role in enhanced load sensitivity of left ventricular relaxation in conscious dogs with tachycardia-induced cardiomyopathy. Circulation 92:3560–3567PubMedGoogle Scholar
  6. 6.
    Leeuwenburgh BP, Steendijk P, Helbing WA, Baan J (2002) Indexes of diastolic RV function: load dependence and changes after chronic RV pressure overload in lambs. Am J Physiol Heart Circ Physiol 282:H1350–1358PubMedGoogle Scholar
  7. 7.
    Leite-Moreira A, Correia-Pinto J, Gillebert T (1999) Load dependence of left ventricular contraction and relaxation. Effects of caffeine. Basic Research in Cardiology 94:284–293PubMedCrossRefGoogle Scholar
  8. 8.
    Leite-Moreira A, Gillebert T (1994) Nonuniform course of left ventricular pressure fall and its regulation by load and contractile state. Circulation 90:2481–2491PubMedGoogle Scholar
  9. 9.
    Varian KD, Janssen PM (2007) Frequency-dependent acceleration of relaxation involves decreased myofilament calcium sensitivity. Am J Physiol Heart Circ Physiol 292:H2212–2219PubMedCrossRefGoogle Scholar
  10. 10.
    Bombardini T (2005) Myocardial contractility in the echo lab: molecular, cellular and pathophysiological basis. Cardiovasc Ultrasound 3:27PubMedCrossRefGoogle Scholar
  11. 11.
    Khouri SJ, Maly GT, Suh DD, Walsh TE (2004) A practical approach to the echocardiographic evaluation of diastolic function. J Am Soc Echocardiogr 17:290–297PubMedCrossRefGoogle Scholar
  12. 12.
    Weiss JL, Frederiksen JW, Weisfeldt ML (1976) Hemodynamic determinants of the timecourse of fall in canine left ventricular pressure. J Clin Invest 58:751–760PubMedCrossRefGoogle Scholar
  13. 13.
    Nikolic S, Yellin EL, Tamura K, et al (1988) Passive properties of canine left ventricle: diastolic stiffness and restoring forces. Circ Res 62:1210–1222PubMedGoogle Scholar
  14. 14.
    Little WC, Ohno M, Kitzman DW, Thomas JD, Cheng CP (1995) Determination of left ventricular chamber stiffness from the time for deceleration of early left ventricular filling. Circulation 92:1933–1939PubMedGoogle Scholar
  15. 15.
    Poelaert J, Declerck C, Vogelaers D, Colardyn F, Visser CA (1997) Left ventricular systolic and diastolic function in septic shock. Intensive Care Med 23:553–560PubMedCrossRefGoogle Scholar
  16. 16.
    Isaaz K, Thompson A, Ethevenot G, Cloez JL, Brembilla B, Pernot C (1989) Doppler echocardiographic measurement of low velocity motion of the left ventricular posterior wall. Am J Cardiol 64:66–75PubMedCrossRefGoogle Scholar
  17. 17.
    McDicken WN, Sutherland GR, Moran CM, Gordon LN (1992) Colour Doppler velocity imaging of the myocardium. Ultrasound Med Biol 18:651–654PubMedCrossRefGoogle Scholar
  18. 18.
    Garcia MJ, Thomas JD, Klein AL (1998) New Doppler echocardiographic applications for the study of diastolic function. J Am Coll Cardiol 32:865–875PubMedCrossRefGoogle Scholar
  19. 19.
    Miyatake K, Yamagishi M, Tanaka N, et al (1995) New method of evaluating left ventricular wall motion by color-coded tissue Doppler imaging: in vitro and in vivo studies. J Am Coll Cardiol 25:717–724PubMedCrossRefGoogle Scholar
  20. 20.
    Ommen SR, Nishimura RA, Appleton CP, et al (2000) Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: A comparative simultaneous Doppler-catheterization study. Circulation 102:1788–1794PubMedGoogle Scholar
  21. 21.
    Ama R, Segers P, Roosens C, Claessens T, Verdonck P, Poelaert J (2004) Effects of load on systolic mitral annular velocity by tissue Doppler imaging. Anesth Analg 99:332–338PubMedGoogle Scholar
  22. 22.
    Poelaert J, Roosens C (2007) Is tissue Doppler echocardiography the Holy Grail for the intensivist? Crit Care 11:135PubMedCrossRefGoogle Scholar
  23. 23.
    Jacques DC, Pinsky MR, Severyn D, Gorcsan J, III (2004) Influence of Alterations in Loading on Mitral Annular Velocity by Tissue Doppler Echocardiography and Its Associated Ability To Predict Filling Pressures. Chest 126:1910–1918PubMedCrossRefGoogle Scholar
  24. 24.
    Vignon P, Allot V, Lesage J, Martaillé J-F, François B, Gastinne H (2007) Diagnosis of left ventricular diastolic dysfunction in the setting of acute changes in loading conditions. Crit Care 11:R43PubMedCrossRefGoogle Scholar
  25. 25.
    Roosens CD, Ama R, Leather HA, et al (2006) Hemodynamic effects of different lung-protective ventilation strategies in closed-chest pigs with normal lungs. Crit Care Med 34:2990–2996PubMedGoogle Scholar
  26. 26.
    von Bibra H, Tuchnitz A, Klein A, Schneider-Eicke J, Schomig A, Schwaiger M (2000) Regional diastolic function by pulsed Doppler myocardial mapping for the detection of left ventricular ischemia during pharmacologic stress testing: a comparison with stress echocardiography and perfusion scintigraphy. J Am Coll Cardiol 36:444–452CrossRefGoogle Scholar
  27. 27.
    Nagueh SF, Sun H, Kopelen HA, Middleton KJ, Khoury DS (2001) Hemodynamic determinants of the mitral annulus diastolic velocities by tissue Doppler. J Am Coll Cardiol 37:278–285PubMedCrossRefGoogle Scholar
  28. 28.
    D’hooghe J, Jamal F, Bijnens B, et al (2000) Calculation of strain values from strain rate values: how should this be done ? In: IEEE International Ultrasonics Symposium Proceedings, pp 1269–1272Google Scholar
  29. 29.
    Weil M (1998) The assault on the Swan Ganz catheter. A case history of constrained technology, constrained bedside clinicians, and constrained monetary expenditures. Chest 113: 1379–1386PubMedCrossRefGoogle Scholar
  30. 30.
    Michel-Cherqui M, Ceddaha A, Liu N, et al (2000) Assessment of systematic use of intraoperative transesophageal echocardiographic during cardiac surgery in adults: a prospective study of 203 patients. J Cardiothorac Vasc Anesth 14:45–50PubMedCrossRefGoogle Scholar
  31. 31.
    Pruszczyk P, Torbicki A, Kuch-Wocial A, Szulc M, Pacho R (2001) Diagnostic value of transoesophageal echocardiography in suspected haemodynamically significant pulmonary embolism. Heart 85:628–634PubMedCrossRefGoogle Scholar
  32. 32.
    Poelaert J (2006) The failing heart under stress: echocardiography is an essential monitoring tool in the intensive care unit. Semin Cardiothorac Vasc Anesth 10:111–115PubMedCrossRefGoogle Scholar
  33. 33.
    Poelaert JI, Schupfer G (2005) Hemodynamic monitoring utilizing transesophageal echocardiography: The relationships among pressure, flow, and function. Chest 127:379–390PubMedCrossRefGoogle Scholar
  34. 34.
    Nagueh S, Mikati I, Kopelen H, Middleton K, Quinonens M, Zoghbi W (1998) Doppler estimation of left ventricular filling pressure in sinus tachycardia. A new application of tissue Doppler imaging. Circulation 98:1644–1650PubMedGoogle Scholar
  35. 35.
    Combes A, Arnoult F, Trouillet JL (2004) Tissue Doppler imaging estimation of pulmonary artery occlusion pressure in ICU patients. Intensive Care Med 30:75–81PubMedCrossRefGoogle Scholar
  36. 36.
    Bouhemad B, Nicolas-Robin A, Benois A, Lemaire S, Goarin JP, Rouby JJ (2003) Echocardiographic Doppler assessment of pulmonary capillary wedge pressure in surgical patients with postoperative circulatory shock and acute lung injury. Anesthesiology 98:1091–1100PubMedCrossRefGoogle Scholar
  37. 37.
    D’Souza KA, Mooney DJ, Russell AE, Maclsaac AI, Aylward PE, Prior DL (2005) Abnormal septal motion affects early diastolic velocities at the septal and lateral mitral annulus, and impacts on estimation of the pulmonary capillary wedge pressure. J Am Soc Echocardiogr 18:445–453CrossRefGoogle Scholar
  38. 38.
    Poelaert J, Mayo P (2007) Education and evaluation of knowledge and skills in echocardiography: how should we organize? Intensive Care Med 33:1684–1686PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media Inc. 2008

Authors and Affiliations

  • J. Poelaert
    • 1
  • E. Osipowska
    • 1
  • C. Verborgh
    • 1
  1. 1.Department of AnesthesiologyUniversity Hospital of BrusselsBrusselsBelgium

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