Contemporary notion of evaluation of the diastolic cardiac function and its role in the development of heart failure

Diastolic cardiac function depends on active relaxation of cardiomyocytes and passive diastolic properties of ventricles. Deterioration of the latter should consistently be followed by hemodynamic abnormalities such as elevated filling pressure or diminished ventricular diastolic dimension. Slowing of relaxation can also be accompanied by similar changes especially in the presence of pronounced tachycardia, but more often it remains compensated and does not affect hemodynamics. According to this notion noninvasive investigation of cardiac diastolic function should at minimum provide estimates of the state of relaxation and filling pressure level. This would allow to evaluate indirectly passive diastolic properties of a ventricle. Standard doppler study of mitral blood flow in most cases is not able to give an answer to these questions. Therefore it is necessary to search novel techniques and their combinations aimed at solution of this problem. At present it seems most adequate to combine assessment of relaxation by one-dimensional color Doppler echocardiography and estimation of filling pressure by blood flow through pulmonary veins.