Chamber quantification/functional assessment

Question 1

what is the equation for fractional shortening and what is the normal range?

Answer 1

FS= (LVIDd - LVIDs) / LVIDd x 100

normal range: 25-40%

Question 2

what is normal value for septal E-point separation and what does it mean if it’s abnormal?

Answer 2

normal is < 7mm, an elevated septal E-point separation suggests low LV systolic function

Question 3

what is B-bump on mitral valve M-mode and what does it connote?

Answer 3

B-bump on MV M-mode is when there is a third bump after the E and A excursions of the mitral valve, due to interrupted closure of the mitral valve ahead of systole, seen in patients with high LVEDP

Question 4

what is the equation for right ventricular index of myocardial performance and what are the abnormal cutoffs?

Answer 4

RIMP= (IVCT + IVRT) / RV ET or (TV closure to open time - RV ET) / RV ET

abnormal is > 0.43 for PW and > 0.54 for TDI

Question 5

What is the equation for calculating PCWP using mitral E velocity and Vp (velocity of propagation on color M-mode of mitral valve)?

Answer 5

PCWP= 4.6 + 5.27(E/Vp)

Question 6

What is the equation for calculating LAP using mitral E velocity and mitral annulus e’ velocity?

Answer 6

LAP= 1.9 + 1.24(E/e’)

Question 7

How can one calculate PVR using PASP and PADP?

Answer 7

PVR= (mean pulm pressure - LAP) / Qp
Mean pulm pressure= 2/3(PADP) + 1/3 PASP

So PVR= 2/3PADP + 1/3PASP / Qp …gives you the PVR in Woods units

Question 8

How is dP/dt calculated?

Answer 8

dP/dt gives a sense of systolic function

dP/dt= (change in pressure between pressure at 1m/s and 3m/s) / (relative time interval between 1m/s and 3/ms expressed in seconds not milliseconds)
= 36-4/ relative time interval

Question 9

what are the upper limits of normal for 3D derived EDV and ESV

Answer 9

EDV: 79mL for men and 71 for women
ESV: 32 for men and 28 for women

Question 10

How is dP/dt calculated?

Answer 10

dP/dt gives a sense of systolic function

dP/dt= (change in pressure between pressure at 1m/s and 3m/s) / (relative time interval between 1m/s and 3/ms expressed in seconds not milliseconds)

Question 11

what is normal dP/dt?

Answer 11

greater than or equal to 1200mmHg/s

Question 12

what does elevated atrial reversal peak velocity signify?

Answer 12

atrial reversal peak velocity of >/= 35cm/s suggests elevated left ventricular end diastolic pressure

also, atrial reversal wave that is >/= 30ms longer in duration than the mitral inflow A wave is also suggestive of high LVEDP

(both the duration and peak velocity of the atrial reversal wave increases when LVEP is high)

Question 13

what does elevated LAP do to the ratio of systolic wave peak velocity to diastolic wave peak velocity of pulmonary venous tracings

Answer 13

S/D ratio decreases when LAP is elevated

Question 14

what is annulus paradoxus?

Answer 14

the concept that in constrictive pericarditis there is an inverse relationship between E/e’ and PCWP rather than direct relationship

Question 15

what is the equation to calculate left atrial volume using area-length method?

Answer 15

LAV= 8 x (area in A4C) x (area in A2C) / 3 x pi x length

where length is the shorter of the two lengths (A4C vs A2C)

Question 16

what is normal value for velocity of propagation in young people vs elderly?

Answer 16

young: normal Vp is > 55
elderly: normal Vp is > 45

Question 17

what is annulus paradoxus?

Answer 17

the concept that in constrictive pericarditis there is an inverse relationship between E/e’ and PCWP

Question 18

what is the normal range for radial strain?

Answer 18

40-60%

Question 19

what’s the equation for LV mass?

Answer 19

LV mass= 1.04[(IVS + LVIDd + PWT)^3 - LVIDd^3] - 13.6

Question 20

What is the timing of contraction like in ischemia?

Answer 20

In ischemia there should be delayed contraction in visual assessment and delayed peak strain on strain curves?

Question 21

how does valsalva help with diastology?

Answer 21

helps distinguish normal from pseudo normal:
decrease in E/A ration of 50% or more with valsalva is suggestive of pseudo normal filling or high LA pressures (using absolute A, in other words peak A minus E height at onset of A)

Question 22

what does pulmonary vein Ar velocity greater than or equal to 35cm/s suggest?

Answer 22

elevated LVEDP

Question 23

how is Ar - A duration difference in PV flow used?

Answer 23

Ar-A difference (difference between duration of PV Ar duration and mitral A wave duration) of > 30ms suggests elevated LVEDP which can help identify early phases of diastolic dysfunction and is an age-independent variable

Question 24

in pulm vein analysis what is systolic filling fraction and how is it used?

Answer 24

systolic filling fraction= VTI of S wave / (VTI of S wave + VTI of D wave)
systolic filling fraction < 40% suggests low LA compliance and increased mean LA pressure

Question 25

what is considered a normal flow propagation velocity?

Answer 25

flow propagation velocity (Vp) > 50 cm/s is normal

Question 26

how does E/Vp predict PCWP?

Answer 26

E/Vp >/= 2.5 predicts PCWP > 15mmHg with reasonable accuracy

Question 27

What is the cascade of abnormalities in ischemia

Answer 27

Normal —> perfusion abnormality —> diastolic dysfunction—> strain abnormality —> systolic dysfunction —> hemodynamic abnormalities—> ECG abnormality—> chest pain

Question 28

what is the cutoff for global longitudinal strain which predicts subclinical LV dysfunction?

Answer 28

reduction in GLS of > 15%

Question 29

How is cardiotoxicity defined when it comes to LVEF?

Answer 29

reduction in LVEF of > 10% to cause EF < 53%

Question 30

How can mean PA pressure be calculated using PV acceleration time?

Answer 30

mPAP= 80 - 0.5(PV acceleration time)

Question 31

how should RV wall thickness be measured by ASE guidelines and what’s the cutoff for RVH?

Answer 31

ideally measured in subcostal view where RV free wall is perpendicular to US beam;
RVH by echo is wall thickness >/= 5mm