Skip to main content Accessibility help
  • Print publication year: 2010
  • Online publication date: May 2010

9 - Left ventricular systolic and diastolic function

from Section 1 - Fundamentals of transesophageal echocardiography


Transesophageal echocardiography (TEE) is a relatively recent development in imaging. In 1997 the American College of Cardiology (ACC) and the American Heart Association (AHA) published guidelines for the clinical application of echocardiography. Routine intraoperative use of TEE has been shown to lead to an improvement in both surgical and anesthetic management, which presumably is translated into better and more consistent outcomes for patients. The use of TEE as a diagnostic tool in the echo lab, and as a diagnostic and monitoring tool during and after cardiac or other major operations, has increased significantly. In Europe, the problem of training and accreditation in perioperative TEE has been addressed, during the last decade, by the European Association of Echocardiography (EAE), which is a formal association of the European Society of Cardiology (ESC), and the European Association of Cardiothoracic Anaesthesiologists (EACTA).

Related content

Powered by UNSILO


1. OdellDH, CahalanMK. Assessment of left ventricular global and segmental systolic function with transesophageal echocardiography. Anesthesiol Clin 2006; 24: 755–62.
2. DouglasPS, KhandheriaB, StainbackRF, WeissmanNJ. ACCF/ASE/ACEP/ASNC/SCAI/SCCT/SCMR 2007 appropriateness criteria for transthoracic and transesophageal echocardiography. J Am Soc Echocardiogr 2007; 20: 787–805.
3. WallerBF, TaliercioCP, SlackJD, et al. Tomographic views of normal and abnormal hearts: the anatomic basis for various cardiac imaging techniques, Part I. Clin Cardiol 1990; 13: 804–12.
4. WallerBF, TaliercioCP, SlackJD, et al. Tomographic views of normal and abnormal hearts: the anatomic basis for various cardiac imaging techniques, Part II. Clin Cardiol 1990; 13: 877–84.
5. PoelaertJI, TrouerbachJ, De BuyzereM, EveraertJ, ColardynFA. Evaluation of transesophageal echocardiography as a diagnostic and therapeutic aid in a critical care setting. Chest 1995; 107: 774–9.
6. ShanewiseJS, CheungAT, AronsonS, et al. ASE/SCA guidelines for performing a comprehensive intraoperative multiplane transoesophageal echocardiography examination: recommendations of the American Society of Echocardiography Council for Intraoperative Echocardiography and the Society of Cardiovascular Anesthesiologists Task Force for Certification in Perioperative Transesophageal Echocardiography. J Am Soc Echocardiogr 1999; 12: 884–900.
7. CheitlinMD, ArmstrongWF, AurigemmaGP, et al. ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography). Circulation 2003; 108: 1146–62.
8. HenryWL, DeMariaA, GramiakR, et al. Report of the American Society of Echocardiography Committee on Nomenclature and Standards in Two-dimensional Echocardiography. Circulation 1980; 62: 212–17.
9. SchillerNB, ShahPM, CrawfordM, et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. J Am Soc Echocardiogr 1989; 2: 358–67.
10. LangRM, BierigM, DevereuxRB, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 2005; 18: 1440–63.
11. Standardization of cardiac tomographic imaging. From the Committee on Advanced Cardiac Imaging and Technology, Council on Clinical Cardiology, American Heart Association; Cardiovascular Imaging Committee, American College of Cardiology; and Board of Directors, Cardiovascular Council, Society of Nuclear Medicine. Circulation 1992; 86: 338–9.
12. ColomboPC, MunicinoA, BrofferioA, et al. Cross-sectional multiplane transesophageal echocardiographic measurements: comparison with standard transthoracic values obtained in the same setting. Echocardiography 2002; 19: 383–90.
13. SiostrzonekP, MundiglerG, HassanA, ZehetgruberM. Echocardiographic diagnosis of segmental wall motion abnormalities. Acta Anaesthesiol Scand Suppl 1997; 111: 271–4.
14. NaharT, CroftL, ShapiroR, et al. Comparison of four echocardiographic techniques for measuring left ventricular ejection fraction. Am J Cardiol 2000; 86: 1358–62.
15. HozumiT, ShakudoM, ShahPM. Quantitation of left ventricular volumes and ejection fraction by biplane transesophageal echocardiography. Am J Cardiol 1993; 72: 356–9.
16. GuarracinoF. [The role of transesophageal echocardiography in intraoperative hemodynamic monitoring] Minerva Anestesiol 2001; 67: 320–4.
17. JackaMJ, CohenMM, ToT, DevittJH, ByrickR. The use of and preferences for the transesophageal echocardiogram and pulmonary artery catheter among cardiovascular anesthesiologists. Anesth Analg 2002; 94: 1065–71.
18. HameedAK, GosalT, FangT, et al. Clinical utility of tissue Doppler imaging in patients with acute myocardial infarction complicated by cardiogenic shock. Cardiovasc Ultrasound 2008; 6: 11.
19. CerqueiraMD, WeissmanNJ, DilsizianV, et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation 2002; 105: 539–42.
20. HogueCW, Dávila-RománVG. Detection of myocardial ischemia by transesophageal echocardiographically determined changes in left ventricular area in patients undergoing coronary artery bypass surgery. J Clin Anesth 1997; 9: 388–93.
21. KolevN, IhraG, SwanevelderJ, et al. Biplane transoesophageal echocardiographic detection of myocardial ischaemia in patients with coronary artery disease undergoing non-cardiac surgery: segmental wall motion vs. electrocardiography and haemodynamic performance. Eur J Anaesthesiol 1997; 14: 412–20.
22. ShanewiseJS. How to reliably detect ischemia in the intensive care unit and operating room. Semin Cardiothorac Vasc Anesth 2006; 10: 101–9.
23. Macieira-CoelhoE, DionísioI, Garcia-AlvesM, et al. Comparison between dobutamine echocardiography and thallium-201 scintigraphy in detecting residual stenosis, ischemia, and necrosis in patients with prior myocardial infarction. Clin Cardiol 1997; 20: 351–6.
24. NgAC, TranD, NewmanM, et al. Comparison of myocardial tissue velocities measured by two-dimensional speckle tracking and tissue Doppler imaging. Am J Cardiol 2008; 102: 784–9.
25. Mor-AviV, SpencerK, GorcsanJ, et al. Normal values of regional left ventricular endocardial motion: multicenter color kinesis study. Am J Physiol Heart Circ Physiol 2000; 279: H2464–76.
26. GarciaMJ, RodriguezL, AresM, et al. Myocardial wall velocity assessment by pulsed Doppler tissue imaging: characteristic findings in normal subjects. Am Heart J 1996; 132: 648–56.
27. BatterhamA, ShaveR, OxboroughD, WhyteG, GeorgeK. Longitudinal plane colour tissue-Doppler myocardial velocities and their association with left ventricular length, volume, and mass in humans. Eur J Echocardiogr 2008; 9: 542–6.
28. OlsonJM, SamadBA, AlamM. Prognostic value of pulse-wave tissue Doppler parameters in patients with systolic heart failure. Am J Cardiol 2008; 102: 722–5.
29. MinhajM, PatelK, MuzicD, et al. The effect of routine intraoperative transesophageal echocardiography on surgical management. J Cardiothorac Vasc Anesth. 2007; 21: 800–4.
30. SwaminathanM, MorrisRW, De MeytsDD, et al. Deterioration of regional wall motion immediately after coronary artery bypass graft surgery is associated with long-term major adverse cardiac events. Anesthesiology 2007; 107: 739–45.
31. GarciaMJ. Comprehensive echocardiographic assessment of diastolic function. Heart Fail Clin 2006; 2: 163–78.
32. GarciaMJ, ThomasJD, KleinAL. New Doppler echocardiographic applications for the study of diastolic function. J Am Coll Cardiol 1998; 32: 865–75.
33. ThomasJD, WeymanAE. Echocardiographic Doppler evaluation of left ventricular diastolic function: physics and physiology. Circulation 1991; 84: 977–90.
34. KasnerM, WestermannD, SteendijkP, et al. Utility of Doppler echocardiography and tissue Doppler imaging in the estimation of diastolic function in heart failure with normal ejection fraction: a comparative Doppler-conductance catheterization study. Circulation 2007; 116: 637–47.
35. LabovitzAJ, PearsonAC. Evaluation of left ventricular diastolic function: clinical relevance and recent Doppler echocardiographic insights. Am Heart J 1987; 114: 836–51.
36. MizunoH, OhteN, WakamiK, et al. Peak mitral annular velocity during early diastole and propagation velocity of early diastolic filling flow are not interchangeable as the parameters of left ventricular early diastolic function. Am J Cardiol 2008; 101: 1467–71.
37. GarciaMJ, SmediraNG, GreenbergNL, et al. Color M-mode Doppler flow propagation velocity is a preload insensitive index of left ventricular relaxation: animal and human validation. J Am Coll Cardiol 2000; 35: 201–8.
38. NaguehSF, MiddletonKJ, KopelenHA, ZoghbiWA, QuiñonesMA. Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. J Am Coll Cardiol 1997; 30: 1527–33.
39. RakowskiH, AppletonC, ChanKL, et al. Canadian consensus recommendations for the measurement and reporting of diastolic dysfunction by echocardiography: from the Investigators of Consensus on Diastolic Dysfunction by Echocardiography. J Am Soc Echocardiogr 1996; 9: 736–60.
40. WangM, YipGW, WangAY, et al. Peak early diastolic mitral annulus velocity by tissue Doppler imaging adds independent and incremental prognostic value. J Am Coll Cardiol 2003; 41: 820–6.
41. SohnDW, ChaiIH, LeeDJ, et al. Assessment of mitral annulus velocity by Doppler tissue imaging in the evaluation of left ventricular diastolic function. J Am Coll Cardiol 1997; 30: 474–80.
42. PalecekT, LinhartA, BultasJ, AschermannM. Comparison of early diastolic mitral annular velocity and flow propagation velocity in detection of mild to moderate left ventricular diastolic dysfunction. Eur J Echocardiogr 2004; 5: 196–204.
43. BukachiF, WaldenströmA, MörnerS, et al. Age dependency in the timing of mitral annular motion in relation to ventricular filling in healthy subjects: Umea General Population Heart Study. Eur J Echocardiogr 2008; 9: 522–9.
44. FukutaH, LittleWC. Diagnosis of diastolic heart failure. Curr Cardiol Rep 2007; 9: 224–8.
45. ArquesS, RouxE, LuccioniR. Current clinical applications of spectral tissue Doppler echocardiography (E/E’ ratio) as a noninvasive surrogate for left ventricular diastolic pressures in the diagnosis of heart failure with preserved left ventricular systolic function. Cardiovasc Ultrasound 2007; 5: 16.
46. ZileMR, LewinterMM. Left ventricular end-diastolic volume is normal in patients with heart failure and a normal ejection fraction: a renewed consensus in diastolic heart failure. J Am Coll Cardiol 2007; 49: 982–5.
47. TeiC, LingLH, HodgeDO, et al. New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function: a study in normals and dilated cardiomyopathy. J Cardiol 1995; 26: 357–66.
48. GuarracinoF, LapollaF, DanellaA, et al. Reduced compliance of left ventricle. Minerva Anestesiol 2004; 70: 225–8.
49. VoonWC, SuHM, YenHW, et al. Validation of isovolumic relaxation flow propagation velocity as an index of ventricular relaxation. Ultrasound Med Biol 2007; 33: 1098–103.