Evaluation of Diastolic Function Flashcards
Week 5
____ comprises approximately 2/3 of the cardiac cycle.
Diastole
What are the four assessments of diastolic function?
- LA size
- Mitral valve inflow
- Pulmonary vein flow
- Tissue Doppler
Diastole can be divided into what four phases related to mechanical events?
- Isovolumic relaxation time (IVRT)
- Early rapid filling phase (E wave)
- Diastasis
- Late filling (A wave)
What are the most clinically relevant parameters of diastolic function?
- Ventricular relaxation
- Myocardial or chamber compliance - stiffness
- Filling pressures
Ventricular Compliance is a ____ process that influences all three filling phases of diastole.
Passive
Myocardial stiffness and chamber stiffness alter ____ ____.
Ventricular compliance
If a ventricle is ____, it will not passively accept the blood from the atrium.
Stiff
Diastolic filling pressures include ____ ____ ____-____ ____ and ____ ____ ____ ____.
Left ventricular end-diastolic pressure (LVEDP) and mean left atrial pressure (LAP).
____ reflects ventricular pressure after filling is complete.
LVEDP
____ ____ ____ (LAP) is the average pressure in the LA during diastole.
Left atrial pressure
M-mode is most useful in the ____ evaluation
Systolic
What is normal LV wall thickness?
6-10mm
LV wall motion ____ may suggest possible CAD or MI.
Abnormalities
What are the clinically useful measured diastolic parameters?
- Isovolumic relaxation time (IVRT)
- Deceleration time (DT)
- E and A velocities
- E/A ratio
- A wave duration
- Pulmonary vein S, D and AR velocities
What is IVRT (isovolumic relaxation time)?
The time between aortic valve closure and mitral valve opening.
What is the normal IVRT range?
60-100 msec
An IVRT < ____ msec indicates decreased compliance and increased filling pressures
60 msec
An IVRT > ____ msec indicates impaired relaxation
100 msec
What is normal mitral inflow DT?
150-220 msec
Young, healthy patients often have DT < ____ msec and this is normal.
150 msec
Any DT < ____ msec or > ____ msec is abnormal in an older adult
150 msec; 240 msec
In a normal mitral inflow pattern, the E wave exceeds the A-wave, so the E/A ratio is more than ____.
1.0
S1 of pulmonary venous flow represents ____ ____.
Atrial relaxation
The pulmonary vein “D” wave occurs after ____ ____ opening.
Mitral valve
In a normal pulmonary inflow pattern, S velocity is ____ than D velocity.
Higher
In a normal pulmonary inflow pattern, AR velocity is less than ____ cm/s
35 cm/s
In a normal pulmonary inflow pattern, the AR – A duration (Mv-inflow) is less than ____.
20
With prolonged relaxation the E/A ratio will be less than ____.
1.0
With impaired pulmonary relaxation, D velocity ____ the transmitral E velocity.
Parallels
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).
Pseudonormalization
Which diastolic pattern is characterized by E/A ration between 1-1.5?
Pseudonormal (Grade II)
A pseudonormal diastolic pattern in characterized by a DT of ____ ms.
150-220 ms
The pulmonary vein pattern and the ____ maneuver will help differentiate pseudonormal from a normal pattern.
Valsalva
In pseudonormalization, the S velocity will be ____ than the D velocity, and the atrial reversal wave will be prominent.
Lower
A pseudonormal diastolic pattern in characterized by an AR velocity of ____ ms.
> 35 ms
With a restrictive (Reversible-Grade III) diastolic pattern, does the pattern reverse with valsalva?
Yes
A grade III diastolic pattern in characterized by a DT of ____ ms.
< 160 ms
What is used to record the Doppler velocities within the myocardium itself?
TDI
TDI measures the ____ of the LV wall movement (E’ and A’).
Velocity
E/e’ > ____ indicates significant diastolic dysfunction (aka - elevated LV filling pressure).
15
In color m-mode, reduced flow velocity = reduced ____.
Slope
In color m-mode, any slope less than ____ cm/sec is indicative of diastolic dysfunction.
45 cm/sec
In general, the higher the E wave velocity, the higher the ____ ____ pressure
Left atrial
The shorter the MV Decel time, the greater the reduction in ventricular ____.
Compliance
According to the new 2016 ASE diastolic dysfunction guidelines: Average E/e’ > ____.
14
According to the new 2016 ASE diastolic dysfunction guidelines: Septal e’ < ____ cm/s
7 cm/s
According to the new 2016 ASE diastolic dysfunction guidelines: Lateral e’ < or = to ____ cm/s.
10 cm/s
According to the new 2016 ASE diastolic dysfunction guidelines: TR vel > m/s
2.8 m/s
According to the new 2016 ASE diastolic dysfunction guidelines: LA volume index > ____ mL/m2.
34 mL/m2
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.
Half
