Evaluation of Diastolic Function

Question 1

____ comprises approximately 2/3 of the cardiac cycle.

Answer 1

Diastole

Question 2

What are the four assessments of diastolic function?

Answer 2

• LA size
• Mitral valve inflow
• Pulmonary vein flow
• Tissue Doppler

Question 3

Diastole can be divided into what four phases related to mechanical events?

Answer 3

• Isovolumic relaxation time (IVRT)
• Early rapid filling phase (E wave)
• Diastasis
• Late filling (A wave)

Question 4

What are the most clinically relevant parameters of diastolic function?

Answer 4

• Ventricular relaxation
• Myocardial or chamber compliance - stiffness
• Filling pressures

Question 5

Ventricular Compliance is a ____ process that influences all three filling phases of diastole.

Answer 5

Passive

Question 6

Myocardial stiffness and chamber stiffness alter ____ ____.

Answer 6

Ventricular compliance

Question 7

If a ventricle is ____, it will not passively accept the blood from the atrium.

Answer 7

Stiff

Question 8

Diastolic filling pressures include ____ ____ ____-____ ____ and ____ ____ ____ ____.

Answer 8

Left ventricular end-diastolic pressure (LVEDP) and mean left atrial pressure (LAP).

Question 9

____ reflects ventricular pressure after filling is complete.

Answer 9

LVEDP

Question 10

____ ____ ____ (LAP) is the average pressure in the LA during diastole.

Answer 10

Left atrial pressure

Question 11

M-mode is most useful in the ____ evaluation

Answer 11

Systolic

Question 12

What is normal LV wall thickness?

Answer 12

6-10mm

Question 13

LV wall motion ____ may suggest possible CAD or MI.

Answer 13

Abnormalities

Question 14

What are the clinically useful measured diastolic parameters?

Answer 14

• Isovolumic relaxation time (IVRT)
• Deceleration time (DT)
• E and A velocities
• E/A ratio
• A wave duration
• Pulmonary vein S, D and AR velocities

Question 15

What is IVRT (isovolumic relaxation time)?

Answer 15

The time between aortic valve closure and mitral valve opening.

Question 16

What is the normal IVRT range?

Answer 16

60-100 msec

Question 17

An IVRT < ____ msec indicates decreased compliance and increased filling pressures

Answer 17

60 msec

Question 18

An IVRT > ____ msec indicates impaired relaxation

Answer 18

100 msec

Question 19

What is normal mitral inflow DT?

Answer 19

150-220 msec

Question 20

Young, healthy patients often have DT < ____ msec and this is normal.

Answer 20

150 msec

Question 21

Any DT < ____ msec or > ____ msec is abnormal in an older adult

Answer 21

150 msec; 240 msec

Question 22

In a normal mitral inflow pattern, the E wave exceeds the A-wave, so the E/A ratio is more than ____.

Answer 22

1.0

Question 23

S1 of pulmonary venous flow represents ____ ____.

Answer 23

Atrial relaxation

Question 24

The pulmonary vein “D” wave occurs after ____ ____ opening.

Answer 24

Mitral valve

Question 25

In a normal pulmonary inflow pattern, S velocity is ____ than D velocity.

Answer 25

Higher

Question 26

In a normal pulmonary inflow pattern, AR velocity is less than ____ cm/s

Answer 26

35 cm/s

Question 27

In a normal pulmonary inflow pattern, the AR – A duration (Mv-inflow) is less than ____.

Answer 27

20

Question 28

With prolonged relaxation the E/A ratio will be less than ____.

Answer 28

1.0

Question 29

With impaired pulmonary relaxation, D velocity ____ the transmitral E velocity.

Answer 29

Parallels

Question 30

When a pattern of prolonged relaxation (Grade I) occurs in the presence of increased preload, the mitral filling pattern approaches a “normal looking” pattern, termed ____ (Grade II).

Answer 30

Pseudonormalization

Question 31

Which diastolic pattern is characterized by E/A ration between 1-1.5?

Answer 31

Pseudonormal (Grade II)

Question 32

A pseudonormal diastolic pattern in characterized by a DT of ____ ms.

Answer 32

150-220 ms

Question 33

The pulmonary vein pattern and the ____ maneuver will help differentiate pseudonormal from a normal pattern.

Answer 33

Valsalva

Question 34

In pseudonormalization, the S velocity will be ____ than the D velocity, and the atrial reversal wave will be prominent.

Answer 34

Lower

Question 35

A pseudonormal diastolic pattern in characterized by an AR velocity of ____ ms.

Answer 35

> 35 ms

Question 36

With a restrictive (Reversible-Grade III) diastolic pattern, does the pattern reverse with valsalva?

Answer 36

Yes

Question 37

A grade III diastolic pattern in characterized by a DT of ____ ms.

Answer 37

< 160 ms

Question 38

What is used to record the Doppler velocities within the myocardium itself?

Answer 38

TDI

Question 39

TDI measures the ____ of the LV wall movement (E’ and A’).

Answer 39

Velocity

Question 40

E/e’ > ____ indicates significant diastolic dysfunction (aka - elevated LV filling pressure).

Answer 40

15

Question 41

In color m-mode, reduced flow velocity = reduced ____.

Answer 41

Slope

Question 42

In color m-mode, any slope less than ____ cm/sec is indicative of diastolic dysfunction.

Answer 42

45 cm/sec

Question 43

In general, the higher the E wave velocity, the higher the ____ ____ pressure

Answer 43

Left atrial

Question 44

The shorter the MV Decel time, the greater the reduction in ventricular ____.

Answer 44

Compliance

Question 45

According to the new 2016 ASE diastolic dysfunction guidelines: Average E/e’ > ____.

Answer 45

14

Question 46

According to the new 2016 ASE diastolic dysfunction guidelines: Septal e’ < ____ cm/s

Answer 46

7 cm/s

Question 47

According to the new 2016 ASE diastolic dysfunction guidelines: Lateral e’ < or = to ____ cm/s.

Answer 47

10 cm/s

Question 48

According to the new 2016 ASE diastolic dysfunction guidelines: TR vel > m/s

Answer 48

2.8 m/s

Question 49

According to the new 2016 ASE diastolic dysfunction guidelines: LA volume index > ____ mL/m2.

Answer 49

34 mL/m2

Question 50

According to the new 2016 ASE diastolic dysfunction guidelines, if more than ____ of the parameters are present, then the patient is positive for diastolic dysfunction.

Answer 50

Half