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1. PTE Masters > Diastolic Function > Flashcards

Diastolic Function Flashcards

1
Q

What is the normal lateral mitral valve e’ velocity?

A

e’ >/= 10cm/sec

e’<8cm/sec = bad

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2
Q

What E/e’ ratio is consistent with Grade 1 diastolic dysfunction?

A

E/e’ <10

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3
Q

What E/e’ ratio is consistent with Grade 3 diastolic dysfunction?

A

E/e’ >14

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4
Q

What E/e’ ratio is consistent with Grade 2 diastolic dysfunction?

A

10-14

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5
Q

What are the 4 stages of diastole?

A
  1. Isovolumetric relaxation (begins at AV closure and ends when MV opens)
  2. Early filling (E wave velocity)
  3. Diastasis (LAP=LVP, no flow across MV)
  4. Late filling (atrial contraction, causes LAP>LVP again and contributes 15-20% LV preload normally but up to 50% in diastolic dysfunction)
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6
Q

How are the 4 stages of diastole reflect on MVI Doppler?

A

Time before E wave = IVRT
E wave = early filling
Time between E and A waves = diastasis
A wave = late filling

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7
Q

What are the two components of diastolic dysfunction?

A

Impaired active ventricular relaxation

Decreased ventricular compliance

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8
Q

What causes the S1 and S2 waves on pulmonary venous Doppler?

A

S1 = atrial relaxation
S2 = RV stroke volume + atrial compliance + mitral annulus descent

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9
Q

What are the limitations of transmitral and pulmonary venous inflow profiles?

A
  • Sensitive to loading conditions
  • MR (increases LAP)
  • MS (increases LAP)
  • Arrhythmias (if the atrium contracts against a closed mitral valve)
  • HR
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10
Q

How is color M-mode flow Vp measured?

A
  • ME 4C view
  • CFD with narrow sector width
  • M-mode scan line
  • Measure slope of first aliasing velocity from MV annulus to LV apex (4cm into ventricle)
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11
Q

What is normal propagation velocity (Vp)?

A

> 50 cm/sec

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12
Q

What does Vp depend on?

A

Preload (it is load dependent)

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13
Q

When can Vp be used to predict PCWP, and what is the equation?

A
  • Can only be used if LVEF is reduced
  • equation is E/Vp >/= 2.5 predicts PCWP >/= 15
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14
Q

How does E/e’ work in normal patients?

A

E/e’ is unreliable in normal patients, so check first whether the e’ is abnormal before measuring E/e’.

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15
Q

How does e’/a’ change with worsening diastolic dysfunction?

A

e’/a’ decreases with worsening diastolic dysfunction (e’/a’ <1 is bad)

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16
Q

What type of diastolic dysfunction is characterized by E < A?

A

Impaired relaxation

  • normal compliance and ISOLATED impaired active relaxation
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17
Q

What type of diastolic dysfunction is characterized by E&raquo_space; A and S-wave blunting in the pulmonary veins?

A

Restrictive dysfunction

  • decreased compliance and impaired active relaxation
18
Q

What type of diastolic dysfunction is characterized by E > A and S-wave blunting in the pulmonary veins?

A

Pseudonormal

  • decreased compliance and impaired active relaxation
19
Q

What are the limitations of Vp for evaluating diastolic function?

A

-Preload dependent
- can only be used to predict PCWP if LVEF abnormal
- Less reproducible than other measurements

20
Q

How can tissue Doppler be used to distinguish abnormal MVI from tamponade or constrictive pericarditis from other forms of diastolic dysfunction?

A

Lateral mitral annular tissue doppler is NORMAL in tamponade and constrictive pericarditis but ABNORMAL in restrictive infiltrative cardiomyopathy.

21
Q

What MVI pattern is seen in tamponade?

A

Impaired relaxation pattern (E<A)

22
Q

What MVI pattern is seen in constrictive pericarditis?

A

Restrictive patern (E»A)

23
Q

What E/E’ ratio is associated with elevated LV filling pressures?

A

> 14

24
Q

What IVRT/Te’-E is associated with elevated LV filling pressures?

A

<2

25
Q

What E/Vp ratio is associated with elevated LV filling pressures?

A

> /= 2.5 (predicts PCWP>15 in patients with reduced LVEF)

26
Q

What Ardur-Adur is associated with elevated LV filling pressures?

A

> 30msec

27
Q

What MVI E/A ratio is normal?

A

> /= 0.8

28
Q

What peak TR velocity is normal (for diastolic function assessment)?

A

<2.8 m/sec

29
Q

What is the normal LA volume index?

A

<34 mL/m2

30
Q

What MVI E/A ratio is consistent with restrictive (Grade 3) diastolic dysfunction?

A

> 2

31
Q

How does age affect active LV relaxation?

A

There is a progressive decrease in active LV relaxation with age, even in healthy adults.

  • E/A decreases
  • e’ decreases
32
Q

When is the lateral e’ less than the septal e’?

A

Only in constrictive pericarditis. Known as annulus reversus and is due to tethering of the lateral mitral annulus by the pericardium.

33
Q

How do you calculate Te’-E?

A

Measure time from peak of QRS complex to start of e’ (on TDI)

Measure time from peak of QRS complex to start of E wave (on MVI PWD)

Subtract time to E wave from time to e’ (this is Te’-E)

This is prolonged with impaired LV relaxation.

34
Q

What is the normal Te’-E?

A

0-4msec

35
Q

What are the limitations of tissue Doppler?

A
  • Angle dependent
  • Can’t reliably measure mitral annulus velocity if MAC present or prosthetic valve/annular ring
  • e’ is sensitive to preload in NORMAL patients (load independent in patients w/ diastolic dysfunction)
36
Q

What is annular reversus?

A

When the lateral e’ is less than septal e’ (seen in constrictive pericarditis)

37
Q

What is a normal a’?

A

a’ <10cm/sec

a’ should be < e’

38
Q

What is a normal S’?

A

S’ >8cm/sec = normal

S’ <5cm/sec = bad

39
Q

How do you calculate isovolumic acceleration?

A

Measure how long it takes to get from end of a’ to max isovolumic velocity

(how long it takes to generate max isovolumic acceleration)

40
Q

TDI detection of ischemia: what changes are seen?

S’, e’, a’, etc.

A
  • S’ decreases
  • e’ decreases
  • a’ increases
  • max isovolumic velocity decreases

e’/a’ ratio becomes <1

Now have a new peak after the S’ before the e’; known as post-systolic shortening

41
Q

What is post-systolic shortening?

A

Indicates myocardial ischemia; peak that occurs after S’ before e’

1. PTE Masters (14 decks)

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