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[Echocardiographic indices of diastolic function put to the practical test].

Assessment of left ventricular filling pressures is now part of routine echocardiographic examination. It is a semi-quantitative evaluation usually based on analysis of transmitral blood flow. Restrictive type flow associated with poor left ventricular contraction is pathognomonic of increased left ventricular filling pressure: conversely, inversion of the mitral flow velocities is generally reassuring except in the presence of left ventricular hypertrophy. In other cases, it is necessary to complete the analysis with indices of left ventricular relaxation. The authors discuss the advantages of pulsed Doppler tissue imaging at the mitral ring over the propagation velocity in colour M-mode, especially when left ventricular contraction is normal or relatively preserved. In particular, the reproducibility of propagation velocity measurements is poor when the velocities are relatively high (> 50 cm/s) because a small error in measurement at these velocities has large repercussion on the value of the slope. Pulmonary vein flow, reputedly difficult to analyse, may be very valuable. Discordance of the different indices is one of the most difficult daily problems to resolve. However, it is possible to give a reliable "normal filling pressures" or "increased filling pressures" conclusion in over 80% of cases. Echocardiography cannot provide a precise study of diastole and terms such as abnormal relaxation, abnormal compliance or diastolic dysfunction should be avoided.