Echocardiography and other advanced cardiac imaging Flashcards
Sarcoid Cardiac MRI findings are what? this can be seen with what common finding?
Echo’s of Cardiac sarcoid patients typically show late gadolidium enhancement. This can be seen with patients who have intracardiac scarring commonly from EP procedures/
What is the inter variability reading in ejection fraction with Echo’s?
Roughly 6-10% between readers + variability with Volume status. This is mostly seen between 35-50% EF’s.
What is the E wave?
The E wave is the passive filling velocity across the mitral valve. About 70-80% of LV filling happens in this phase
When does the Mitral valve close?
When the LV pressure is higher than the LA pressure
What is the A wave?
This is the “atrial kick” aka the velocity of the flow of blood across the mitral valve with contraction of the atria
What is Grade 1 Diastolic Dysfunction?
G1DD is when the E wave fills slower than normal since there is a higher pressure in the LV
Grade I (impaired relaxation): This is a normal finding and occurs in nearly 100% of individuals by the age of 60. The E wave velocity is reduced resulting in E/A reversal (ratio < 1.0). The left atrial pressures are normal. The deceleration time of the E wave is prolonged measuring > 200 ms. The e/e’ ratio measured by tissue Doppler is normal.
What is Grade II diastolic Dysfunction?
GIIDD is when the LA pressures have increases and the E to e’ ratio is elevated.
Grade II (pseudonormal): This is pathological and results in elevated left atrial pressures. The E/A ratio is normal (0.8 +- 1.5), the deceleration time is normal (160-200 ms), however the e/e’ ratio is elevated. The E/A ratio will be < 1 with Valsalva. A major clue to the presence of grade II diastolic dysfunction as compared to normal diastolic function is the presence of structural heart disease such as left atrial enlargement, left ventricular hypertrophy or systolic dysfunction. If significant structural heart disease is present and the E/A ratio as well as the deceleration time appear normal, suspect a pseudonormal pattern. Valsalva distinguishes pseudonormal from normal as well as the e/e’ ratio. Diuresis can frequently reduce the left atrial pressure relieving symptoms of heart failure and returning the hemodynamics to those of grade I diastolic dysfunction.
What is the E/E’ ratio?
Thus, in the normal heart, myocardial relaxation (e’) and suction precede the onset of LV passive filling (E)
Transmitral inflow is proportionate to the ratio between LA pressure and the relaxation time constant, tau, whereas e’ is inversely proportionate to tau only, leading the ratio E/e’ to be proportionate to LA pressure. The use of E/e’ is generally the most a feasible as well as among the most reproducible method for estimation of filling pressure.
In contrast, the failing ventricle shows reduction of passive ventricular filling and elevation of LA pressure, so blood is pushed rather than sucked into the LV. In this setting, myocardial diastolic motion (e’) reflecting cardiac movement during diastole may be secondary to filling (E).14) The distinction in the mode of LV filling (and thereby e’) explains the different behaviour of E/e’ with impaired and preserved LV function.
What is Grade III Diastolic Dysfunction?
Grade III (reversible restrictive): This results in significantly elevated left atrial pressures. Also known as a “restrictive filling pattern”, the E/A ratio is > 2.0, the deceleration time is < 160 ms, and the e/e’ ratio is elevated. The E/A ratio changes to < 1.0 with Valsalva. Diuresis can frequently reduce the left atrial pressure relieving symptoms of heart failure and returning the hemodynamics to those of grade I diastolic dysfunction.
Grade IV diastolic Dysfunction is what?
Grade IV (fixed restrictive): This indicates a poor prognosis and very elevated left atrial pressures. The E/A ratio is > 2.0, the deceleration time is low and the e/e’ ratio is elevated. The major difference distinguishing grade III from grade IV diastolic dysfunction is the lack of E/A reversal with the Valsalva maneuver (no effect will be seen with Valsalva). Diuresis will not have a major effect on the left atrial pressures and clinic heart failure is likely permanent. Grade IV diastolic dysfunction is present only in very advanced heart failure and frequently seen in end-stage restrictive cardiomyopathies such as amyloid cardiomyopathy.
Why do we do Cardiac MRI before EP ablations of NSVT (or other odd rhythms)
To check for Cardiac sarcoid. If a patient has Cardiac Sarcoid + Arrhythmia it is indication for ICD placement NOT an ablation
