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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.
To better understand diastolic function, it is crucial to realize that the left ventricle is a mechanical suction pump at, and for a little while after, the mitral valve opening. [5] In other words, when mitral valve opens, the atrium does not push blood into the ventricle, instead, it is the ventricle that mechanically "sucks" in blood from ...
The peak mitral annular velocity during early filling, e' is a measure of left ventricular diastolic function, and has been shown to be relatively independent of left ventricular filling pressure. [12] [13] [14] If there is impaired relaxation (Diastolic dysfunction), the e' velocity decreases. After the early relaxation, the ventricular ...
Velocity measurements allow assessment of cardiac valve areas and function, any abnormal communications between the left and right side of the heart, any leaking of blood through the valves (valvular regurgitation), calculation of the cardiac output and calculation of E/A ratio [2] (a measure of diastolic dysfunction). Contrast-enhanced ...
One parameter to quantify this difference is the pulsatility index (PI), which is equal to the difference between the peak systolic velocity and the minimum diastolic velocity divided by the mean velocity during the cardiac cycle. This value decreases with distance from the heart. [20]
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.
The aortic and pulmonary valves known as the semilunar valves open, and a defined fraction of blood within the heart is ejected into the aorta and pulmonary trunk. Ejection of blood from the heart is known as systole. Ejection causes pressure within the ventricles to fall, and, simultaneously, the atria begin to refill (atrial diastole).
Diastolic dysfunction is associated with a reduced compliance, or increased stiffness, of the ventricle wall. This reduced compliance results in an inadequate filling of the ventricle and a decrease in the end-diastolic volume. The decreased end-diastolic volume then leads to a reduction in stroke volume because of the Frank-Starling mechanism. [1]
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