ECHO - Diastology Flashcards
Question?
NORMAL
What is diastolic function?
A complex sequence of multiple interrelated events:
- relaxation (contraction uncoupling, load, nonuniformity)
- erectile coronary effect
- suction
- viscoelastic forces,
- pericardial restraint
- ventricular interaction
- atrial contraction
- chamber stiffness
- myocardial stress/strain relations
Elements of a Basic Diastolic FUnction assessment
- LAVI
- Mitral inflow doppler
- Mitral annular tissue doppler
- RVSP
for normal LV, diastolic function could be either be normal or abnormal
choose only between the two
for LV with low EF or myocardial disease, diastolic function can be Grade I, II or III
use the abnormal EF algorithm for assessing diastolic dysfunction
in a normal LV, what are the cut off for abnormal diastolic dysfunction
- LAVI >24ml/m^2
- MV E/e’ >14
- septal e’ <7 or lateral e’ of <10cm/s
- TRjet >2.8m/s
**if 1 or none, normal diastolic dysfunction
**if 2 out of 4, intermediate
*** 3 or 4 out of 4, (+) Diastolic dysfunction (>50% probability of DD)
Measuring LAVI
4chamber and 2 chamber view
do not include LAA or aneurysm
cut off: >34ml/m^2
cut off for mitral annulus motion
check the m medial e’, cut off is <7cm/s
lateral e’ is <10cm/s
What does mitral E/e’ represents?
E/e’ ratio - echo surrogate for filling pressure
cut off - >14
grading of diastolic dysfunction base on mitral inflow and mitral annulus velocity
mitral E is increasing while the e’ is decreasing. check the pic
cut off of average Mitral E/e’ ratio
> 14
medial is >15
what is mitral inflow?
- provides insight into the pressure gradient between the LA and LV
for LV with low EF, LVH, dilated LVH or other myocardial disease, which echo parameter will you use to categorized Diastolic Dysfunction?
Mitral inflow E/A and E
E/A ≤0.8 + <50cm/s –> Grade I DD
E/A ≥2.0 —> Grade II DD
if E/A is ≤ 0.8 and E>50cm/s or E/A 0.8-1.9
–> check for MV E/e’ , LAVI and TRjet
–> 2/3 or 3/3 is negative - Grade I DD
–> 2/3 o or 3/3 is positive - Grade II DD
–> if LAP is indeterminate, use LAVI and TRjet
–> if 2 are negative –> Grade I DD
–> 1 negative and 1 positive-> Cannot determine LAD and DD grade
–> if 2 are positive–> grade II DD
Diastolic dysfunction grading based mitral inflow pattern, acceleration time and LAVI, E’ and E/e’
normal LAP or E/e’ in Grade I
grade I - long AT
grade II - normal
grade III - short AT
what is super-normal Diastolic function
E/A of ≥2.0 but normal mitral annulus tissue doppler
effect of valsalva maneuver
done in pseudonormal mitral inflow pattern which the effect of E goes done and A goes up (Grade I DD_
better if check mitral annulus e’ and a’
when not to try assessing the diastolic function
- LBBB
- Tachycardia
- mitral prosthetic valve
- severe MS/MR
add–> PH with marked RV dysfunction
grade of Diastolic dysfunction?
grade III
note the “L wave”
LAVI of 27
grade of Diastolic dysfunction?
normal
Grade of Diastolic dysfunction?
grade III
Grade of Diastolic dysfunction?
LAVI 40
Grade I
