Assessment of diastolic dysfunction: Invasive modalities

In this article, the author sought to review the two primary components of diastolic function that are most directly and accurately determined using invasive methodologies. For chamber relaxation this is optimally achieved using a micromanometer catheter, whereas for chamber compliance (or its inverse stiffness) this is best achieved by combining this catheter with a measure of instantaneous volume from a conductance catheter, using data from multiple cycles. Even with the ideal data set, the analysis of both properties involves physiologic and often mathematical assumptions, and the extent to which the data do not match these assumptions, the derived indexes may be misleading. Care in the data collection, and awareness of the various factors and pitfalls involved with their analysis can undoubtedly improve the interpretations. As advances in noninvasive methods continue to evolve, reliance on invasive methodologies will continue to fade into the background. At present, however, they remain the gold standard for the two primary diastolic properties described, and have clearly played a central role in the evolution of our understanding of cardiac diastolic disease and its treatment.