Comprehensive echocardiographic assessment of diastolic function.

It is now recognized that 30% to 50% of patients who have symptomatic congestive heart failure have preserved left ventricular (LV) ejection fraction [1,2]. Abnormalities in diastolic function not only assume a fundamental role in these but also relate to the severity of symptoms and prognosis in all heart failure patients, regardless of the cause [3,4]. Two-dimensional (2D) and Doppler echocardiography are the most important clinical tools available for the diagnosis of diastolic dysfunction [5]. Echocardiography is widely available, portable, and biologically safe and is also capable of excluding other important causes of heart failure, such as valvular disease. The recent integration of new Doppler modalities in many cases can establish the specific pathophysiologic abnormalities involved and can provide reasonably accurate quantification. In most cases, a comprehensive integration of clinical data, 2D structural information, and Doppler physiologic data is required to provide a complete evaluation. Diastolic dysfunction may be defined as the inability of the heart to maintain an adequate cardiac output under normal filling pressure [6]. This inability may manifest early as impaired exercise tolerance or as overt leftand right-sided heart failure at rest. There are numerous physiologic parameters that can affect LV diastolic function. These parameters interact to maintain LV filling under relatively low atrial