<unk>  is typically diagnosed with echocardiography. Techniques such as catheterization are invasive procedures and thus<unk>  for patients with co-morbid conditions or those who are suspected to have<unk>  but lack clear non-invasive findings. Catheterization does represent are more definitive diagnostic assessment as pressure and volume measurements are taken simultaneously and directly. In either technique, the<unk>  is evaluated for left ventricular diastolic function. Important parameters include, rate of isovolumic relaxation, rate of ventricular filling, and stiffness. Frequently patients are subjected to stress echocardiography, which involves the above assessment of diastolic function during exercise. This is undertaken because perturbations in diastole are exaggerated during the increased demands of exercise. Exercise requires increased left ventricular filling and subsequent output. Typically the<unk>  responds by increasing<unk>  rate and relaxation time. However, in patients with<unk>  both responses are diminished due to increased ventricular stiffness. Testing during this demanding state may reveal abnormalities that are not as discernible at rest. Diastolic dysfunction must be differentiated from diastolic<unk><unk> . Diastolic dysfunction can be found in elderly and apparently quite<unk> hy patients. If diastolic dysfunction describes an abnormal mechanical property, diastolic<unk><unk>  describes a clinical syndrome. Mathematics describing the relationship between the ratio of Systole to Diastole in accepted terms of End Systolic Volume to End Diastolic Volume implies many mathematical solutions to forward and backward<unk><unk> . Criteria for diagnosis of diastolic dysfunction or diastolic<unk><unk>  remain imprecise. This has made it difficult to conduct valid clinical trials of treatments for diastolic<unk><unk> . The problem is compounded by the fact that systolic and diastolic<unk><unk>  commonly coexist when patients present with many ischemic and nonischemic etiologies of<unk><unk> . Narrowly defined, diastolic<unk>  has often been defined as<unk><unk>  with normal systolic function" (i.e. left ventricular<unk><unk>  of 60% or more). Chagasic<unk>  disease may represent an optimal academic model of diastolic<unk><unk>  that spares systolic function. A patient is said to have diastolic dysfunction if he has signs and symptoms of<unk><unk>  but the left ventricular<unk><unk>  is normal. A second approach is to use an elevated BNP level in the presence of normal<unk><unk>  to diagnose diastolic<unk><unk> . Concordance of both volumetric and biochemical measurements and markers lends to even stronger terminology regarding scientific/mathematical expression of diastolic<unk><unk> . These are both probably too broad a definition for diastolic<unk><unk> , and this group of patients is more precisely described as having<unk><unk>  with normal systolic function. Echocardiography can be used to diagnose diastolic dysfunction but is a limited modality unless it is supplemented by stress imaging. MUGA imaging is an earlier mathematical attempt to distinguish systolic from diastolic<unk><unk> . No single echocardiographic parameter can confirm a diagnosis of diastolic<unk><unk> . Multiple echocardiographic parameters have been proposed as sufficiently sensitive and specific, including mitral inflow velocity patterns, pulmonary vein flow patterns, E/A reversal, tissue Doppler measurements, and M-mode echo measurements (i.e. of left atrial size). Algorithms have also been developed which combine multiple echocardiographic parameters to diagnose diastolic<unk><unk> . There are four basic Echocardiographic patterns of diastolic<unk><unk> , which are graded I to IV: * The mildest form is called an "abnormal relaxation pattern", or grade I diastolic dysfunction. On the mitral inflow Doppler echocardiogram, there is reversal of the normal E/A ratio. This pattern may develop normally with age in some patients, and many grade I patients will not have any clinical signs or symptoms of<unk><unk> . * Grade II diastolic dysfunction is called "pseudonormal filling dynamics". This is considered moderate diastolic dysfunction and is associated with elevated left atrial filling pressures. These patients more commonly have symptoms of<unk><unk> , and many have left atrial enlargement due to the elevated pressures in the left<unk> . Grade III and IV diastolic dysfunction are called "restrictive filling dynamics". These are both severe forms of diastolic dysfunction, and patients tend to have advanced<unk><unk>  symptoms: * Class III diastolic dysfunction patients will demonstrate reversal of their diastolic abnormalities on echocardiogram when they perform the Valsalva maneuver. This is referred to as "reversible restrictive diastolic dysfunction". * Class IV diastolic dysfunction patients will not demonstrate reversibility of their echocardiogram abnormalities, and are therefore said to suffer from "fixed restrictive diastolic dysfunction". The presence of either class III and IV diastolic dysfunction is associated with a significantly worse prognosis. These patients will have left atrial enlargement, and many will have a reduced left ventricular<unk><unk>  that indicates a combination of systolic and diastolic dysfunction. Imaged volumetric definition of systolic<unk>  performance is commonly accepted as<unk><unk> . Volumetric definition of the<unk>  in systole was first described by Adolph Fick as cardiac output. Fick may be readily and inexpensively inverted to cardiac output and<unk><unk>  to mathematically describe diastole. Decline of<unk><unk>  paired with decline of E/A ratio seems a stronger argument in support of a mathematical definition of diastolic<unk><unk> . Another parameter to assess diastolic function is the , which is the ratio of mitral peak velocity of early filling (E) to early diastolic mitral annular velocity (E'). Diastolic dysfunction is assumed when the E/E' ratio exceed 15. Newer echocardiographic techniques such as speckle tracking for strain measurement, particularly for the left atrium, are becoming increasingly utilised for the diagnosis of<unk> .
Heart failure with preserved ejection fraction
Ischemic cardiomyopathy
Diabetic cardiomyopathy
Hypertrophic cardiomyopathy
Dilated cardiomyopathy
Restrictive cardiomyopathy
Alcoholic cardiomyopathy
Amyloid cardiomyopathy