EchoBridgeMD Pearl #17: Pathophysiology of Diastolic Dysfunction

Normal left ventricular (LV) filling during diastole occurs when the myocardium relaxes easily and accepts blood compliantly. Early diastolic filling accounts for approximately 70–80% of LV filling, while left atrial (LA) contraction contributes the remaining 20–30%.

With diastolic dysfunction, the myocardium becomes stiff and non-compliant (such as from long-standing hypertension). This leads to elevated LV filling pressures, increased LA pressure, and LA enlargement. When the mitral valve opens, the elevated LA pressure drives blood into the LV. Over time, these elevated filling pressures can lead to pulmonary congestion and exertional dyspnea. Echocardiography can detect these hemodynamic changes before symptoms develop.

Reference:

📖 Nagueh SF, Sanborn DY, Oh JK, et al. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography and for Heart Failure With Preserved Ejection Fraction Diagnosis: An Update From the American Society of Echocardiography. J Am Soc Echocardiogr. 2025.

https://pubmed.ncbi.nlm.nih.gov/40617625/

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