The role of diastolic left ventricular function in the detection of subtle cardiac damage

PhD ceremony: Mr. Y.M. Hummel, 16.15 uur, Academiegebouw, Broerstraat 5, Groningen

Dissteration: The role of diastolic left ventricular function in the detection of subtle cardiac damage

Promotor(s): prof. A.A. Voors, prof. M.P. van den Berg

Faculty: Medical Sciences

This thesis provides evidence of the lack in sensitivity of left ventricular ejection fraction (LVEF) as a tool for detection of subtle cardiac damage. Most often subtle cardiac damage is unaccompanied by a pathological decrease in LVEF, due to technical issues but more importantly morphological changes preserving LVEF. These morphological (i.e. remodeling in extracellular matrix etc.) changes in turn lead to increased stiffness of the myocardium. This thesis supports the role of tissue Doppler velocities as a diagnostic tool in the evaluation of subtle cardiac damage. We provide evidence for the incremental role of diastolic left ventricular function in the detection of subtle cardiac damage in several patient populations.

Using early diastolic tissue velocity (e’) provides clinicians several benefits over other conventional and more sophisticated echocardiographic measurements. From a technical point of view measuring e’ is one of the least volume dependent, highly reproducible and sensitive measurements available to modern day clinicians.

In conclusion; this thesis advocates a more routine use of e’ in clinical practice, especially in patients referred to clinicians based on the suspicion of subtle cardiac damage. Acknowledgement of these subtle signs of cardiac damage might in turn lead to earlier intervention and prevention of heart failure.