title: Role of transesophageal echocardiography in assessing diastolic dysfunction in a large clinical practice: a 9-year experience.
abstract: BACKGROUND
  Two-dimensional transthoracic echocardiography with respiratory monitoring has been used to characterize diseases that impair diastolic function. Transesophageal echocardiography (TEE) has emerged as a complementary technique to evaluate patients with these diseases. The purpose of this study was to evaluate in a large clinical practice the utility of TEE with respiratory monitoring for classification of patients with diastolic dysfunction.
  
  
  METHODS
  Over a 9-year period TEE was used to examine 192 patients referred to an echocardiography laboratory for additional evaluation of abnormal diastolic function. We performed pulsed-wave Doppler TEE of the left ventricular inflow and pulmonary veins and respiratory monitoring to categorize patients as showing restrictive physiologic features, constriction with or without effusion, mixed constriction and restriction, abnormal relaxation, pseudonormalization, large pericardial effusion or tamponade, or normal diastolic function.
  
  
  RESULTS
  Patients with diastolic dysfunction underwent 3% of the total number of transesophageal studies conducted during the study period. Among the 192 patients referred for TEE, abnormal diastolic function was found in 181 (94%); 11 (6%) had normal diastolic function. Seventy-one (39%) of the 181 patients had restrictive physiologic features. Constrictive pericarditis was found in 54 (30%) of the patients and was confirmed for all 31 patients who underwent pericardiectomy. Mixed constriction and restriction was present in 21 (12%) of the patients. The other 35 patients (19%) had abnormal relaxation, pseudonormalization, or large pericardial effusion or tamponade. The cause of diastolic dysfunction was idiopathic for 32% of the patients, previous cardiac operation for 26%, cardiac amyloidosis for 23%, radiation therapy for 11%, and hypertension or advanced ischemic heart disease for 8%.
  
  
  CONCLUSIONS
  Two-dimensional and Doppler TEE with respiratory monitoring is useful in categorizing patients with impaired diastolic function, primarily into those with restrictive physiologic features or constrictive pericarditis.
authors.affiliation: Department of Cardiology, Section of Cardiovascular Imaging, The Cleveland Clinic Foundation, Cleveland, Ohio, USA. kleina@ccf.org
authors.forename: A L
authors.initials: AL
authors.lastname: Klein
authors.forename: M P
authors.initials: MP
authors.lastname: Canale
authors.forename: N
authors.initials: N
authors.lastname: Rajagopalan
authors.forename: R D
authors.initials: RD
authors.lastname: White
authors.forename: R D
authors.initials: RD
authors.lastname: Murray
authors.forename: S
authors.initials: S
authors.lastname: Wahi
authors.forename: K L
authors.initials: KL
authors.lastname: Arheart
authors.forename: J D
authors.initials: JD
authors.lastname: Thomas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001783:Blood Flow Velocity; D006328:Cardiac Catheterization; D018619:Echocardiography, Doppler, Pulsed; D017548:Echocardiography, Transesophageal / Q000379:methods; D005260:Female; D016027:Heart Transplantation; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D015588:Observer Variation; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000503:physiopathology; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology