Imaging assessment of left ventricular diastolic function: current and emerging methods

Left ventricular diastolic dysfunction (LVDD) plays a key role in the pathophysiology of heart failure with preserved ejection fraction and has prognostic implications even in the preclinical stage. The imaging assessment of left ventricular diastolic function is nowadays part of the routine clinical practice. Echocardiography is widely available, safe and versatile, and provides important structural and functional information relevant to diastolic function assessment. The currently used algorithms for LV diastolic function evaluation propose a variety of parameters that reflect different LV diastolic properties, each of them having potential limitations. Thus, there is still significant interobserver variability in classification of LVDD stage and estimation of LV filling pressure in a considerable proportion of studies. This review discusses the currently used methods for the assessment of LV diastolic function, higlighting their strengths and limitations. It also discusses some of the newer techniques with potential clinical impact, emphasizing their additional value and the current challenges inherent to their routine clinical use.