From the Guidelines
Given the normal Left Ventricular (LV) systolic function, normal Left Ventricular (LV) diastolic filling pressure, and normal Right Ventricular (RV) systolic function, the overall assessment of cardiac function is normal, with no indication of diastolic dysfunction or elevated left atrial pressure. The evaluation of left ventricular diastolic function is based on the assessment of relaxation and filling during the period after aortic valve closure and before aortic valve opening, using patterns of mitral inflow and annular velocities, tricuspid regurgitation velocity, left atrial size, and pulmonary vein flow velocities 1. In this case, with normal LV systolic and diastolic function, as well as normal RV systolic function, the cardiac function can be considered overall normal. Key parameters to assess diastolic function include the mitral inflow pattern, with an E/A ratio ≤ 0.8 along with a peak E velocity of ≤50 cm/sec indicating normal diastolic function, and the mitral annular e′ velocity, which can be used to verify the presence of normal diastolic function 1. Additionally, the 2019 ACC/AHA/ASE key data elements and definitions for transthoracic echocardiography provide a framework for evaluating left ventricular diastolic function, including the use of mitral annulus e′ velocity and left atrial size to assess diastolic function 1. Overall, the normal cardiac function suggests a low risk of cardiovascular events and no immediate need for intervention, but regular follow-up with a cardiologist is still recommended to monitor for any changes in cardiac function over time. Some important parameters to monitor include left atrial size, mitral annular e′ velocity, and tricuspid regurgitation velocity, which can provide valuable information about diastolic function and left atrial pressure 1.
From the Research
Cardiac Function Assessment
Given normal Left Ventricular (LV) systolic function, normal Left Ventricular (LV) diastolic filling pressure, and normal Right Ventricular (RV) systolic function, the overall assessment of cardiac function can be evaluated based on various studies.
- The studies 2, 3, 4, 5 focus on the relationship between left ventricular hypertrophy, systolic and diastolic function, and cardiac performance in patients with hypertension or heart failure.
- According to the study 2, patients with concentric left ventricular hypertrophy and a normal ejection fraction may progress to systolic dysfunction, with risk factors including interval myocardial infarction, prolonged QRS interval, and elevated arterial impedance.
- The study 3 introduces a new four-group classification of left ventricular hypertrophy based on left ventricular dilatation and concentricity, which identifies dilated subgroups with reduced left ventricular function.
- The study 4 compares clinical characteristics and outcomes of eccentric versus concentric left ventricular hypertrophy in heart failure with preserved ejection fraction, finding that eccentric hypertrophy denotes a distinct subset of HFpEF with reduced left ventricular contractility.
- The study 5 demonstrates that concentric left ventricular hypertrophy brings deterioration of systolic longitudinal, circumferential, and radial myocardial deformation in hypertensive patients with preserved left ventricular pump function.
- The study 6 emphasizes the importance of echocardiography in diagnosing and managing heart failure, highlighting the value of evaluating systolic, diastolic, left atrial, and right ventricular function, as well as the use of global longitudinal strain by 2D speckle-tracking for optimal risk assessment.
Key Findings
- Normal LV systolic function, normal LV diastolic filling pressure, and normal RV systolic function do not necessarily indicate normal cardiac function, as other factors such as left ventricular hypertrophy and arterial impedance can affect cardiac performance 2, 3, 4, 5.
- Echocardiography is a crucial tool for diagnosing and managing heart failure, providing important prognostic information in both HF with reduced ejection fraction and HFpEF 6.
- A comprehensive assessment of cardiac function should consider multiple parameters, including systolic and diastolic function, left atrial and right ventricular function, and global longitudinal strain 6.