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Chapter 12

In recent years diastolic function has received greater recognition for its impact on overall cardiac performance. Diastole is no longer regarded as a passive phase of the cardiac cycle, but rather as a complex sequence of interrelated events, which are dependent upon loading conditions, heart rate, and contractility, and ultimately influence the systolic function of the left ventricle (LV). Studies have suggested that patients with diastolic dysfunction presenting for cardiac surgery are prone to hemodynamic instability and potentially worse outcomes,1 and that patients with diastolic heart failure are at increased risk for decompensation in the perioperative period.2 Therefore, the perioperative echocardiographer should be familiar with the pathophysiology of diastolic heart failure and understand how to monitor and optimize diastolic function. Although advances in ultrasound technology have rendered Doppler echocardiography as the clinician's “Rosetta Stone” for diastolic function evaluation, this chapter will familiarize the readers with all the echocardiographic techniques routinely employed to assess LV diastolic function, explain the significance of these diastolic indices, and provide a diagnostic algorithm to evaluate diastolic dysfunction.

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