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Echocardiography can be used to diagnose diastolic dysfunction but is a limited modality unless it is supplemented by stress imaging. MUGA imaging is an earlier mathematical attempt to distinguish systolic from diastolic heart failure. [citation needed] No single echocardiographic parameter can confirm a diagnosis of diastolic heart failure.
The reversal of the E/A ratio ('A' velocity becomes greater than 'E' velocity) is often accepted as a clinical marker of diastolic dysfunction, in which the left ventricular wall becomes so stiff as to impair proper filling, which can lead to diastolic heart failure. This can occur, for instance, with longstanding untreated hypertension.
In clinical cardiology the term "diastolic function" is most commonly referred as how the heart fills. [1] Parallel to "diastolic function", the term " systolic function" is usually referenced in terms of the left ventricular ejection fraction (LVEF), which is the ratio of stroke volume and end-diastolic volume . [ 2 ]
Acute decompensated heart failure is a worsening of chronic heart failure symptoms, which can result in acute respiratory distress. [66] High-output heart failure can occur when there is increased cardiac demand that results in increased left ventricular diastolic pressure which can develop into pulmonary congestion (pulmonary edema). [46]
During ventricular diastolic filling, the elevated atrial pressure is transmitted to the LV during filling so that LV end-diastolic volume (and pressure) increases. This would cause the afterload to increase if it were not for the reduced outflow resistance (due to mitral regurgitation) that tends to decrease afterload during ejection.
Volume status should still be adequately evaluated. Some heart failure patients on chronic diuretics can undergo excessive diuresis. In the case of diastolic dysfunction without systolic dysfunction, fluid resuscitation may, in fact, improve circulation by decreasing heart rate, which will allow the ventricles more time to fill.
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