Evaluation of Systolic and Diastolic Function of the Ventricles and Myocardium

A critical aspect of most cardiac catheterization procedures is the evaluation of myocardial function. At its simplest, this consists of a visual assessment of the left ventricular (LV) contractile pattern from the left ventriculogram, together with measurements of LV end-diastolic pressure. In laboratories where most patients have right-sided heart catheterization and cardiac output measurement as part of a standard cardiac catheterization procedure, additional information about LV function may be gleaned from the cardiac output, stroke volume, and pulmonary capillary wedge pressure, whereas right ventricular (RV) function is reflected in the values for right ventricular end-diastolic pressure (RVEDP) and right atrial pressure. Measurements of pressures and cardiac output give important information about overall cardiac function but may shed little light on whether dysfunction is caused by abnormal systolic or diastolic myocardial performance. This chapter describes some of the specific methods that can be used in the cardiac catheterization laboratory to examine myocardial performance in systole and diastole.