LV Systolic Performance and Pathology Flashcards
How is LV wall thickness assessed?
Septal wall and inferolateral wall measurements of thickness at end diastole in the Transgastric mid short axis view.
What is the cutoff for men and women for normal Left Ventricular wall thickness?
Men 0.6 to 1.0 cm; women 0.6 to 0.9 cm
Formula for relative wall thickness?
Relative wall thickness is = 2 x PWTd/LVIDd
LVIDd - minor-axis diameter measruement in diastole
PWTd - posterior wall diameter in diastole
What is LVIDd? How is it measured?
minor/short axis diameter. Measured below level of mitral valve tips and perpendicular to the long-axis.
Measured in the midesophageal 2 chamber view or TG two chamber view at the level of the papillary muscles.
What are the normal values for men and women for minor-axis diameter LVID?
In diastole : men 50.2 ± 4.1 mm and women 45.0 ± 3.6 mm
In systole : men 32.4 ± 3.7 mm and women 28.2 ± 3.3 mm
In general, a minor-axis diameter greater than 5.4 cm during diastole is considered enlarged.
How many disks are used in the modified Simpson’s Rule?
20 disks.
Do volumes from 3D data sets or 2D data sets tend to be higher?
3 D data sets
Is LV mass or low EF a stronger predictor for all cause mortality and cardiac event rates?
LV Mass
What are normal LV mass values for men and women?
67 to 162 g for women and 88 to 224 g for men
What two views are needed to calculate a Simpson’s biplane?
ME four chamber and ME two chamber views in diastole and systole.
What is the density of LV muscle mass in g/mL?
1.05 g/mL
How is LV mass calculated?
myocardial tissue Density x (Volume encompassed by LV epicardium - Volume of LV cavity)
What defines end diastole in echo?
first frame after mitral valve closure or the frame in the cardiac cycle in which the respective measurement is the largest.
What defines End Systole?
Frame after aortic valve closure or the frame in which the measurement is smallest.
What is formula for Endocardial fractional shortening?
What are normal values?
(LVIDd - LVIDs)/LVIDd
men 25% to 43%, women 27% to 45%
What is formula for Fractional area change?
Normal values?
Fractional area change (FAC) (%) = {(LVAd − LVAs)/LVAd} × 100
Normal values: >35%
How is a dP/dT measurement done for LV systolic function?
Simplified Bernoulli equation using 1 m/s and 3 m/s to get pressure differential then divided by timepoint.
[4(3)2] – [4(1)2] = 32 mm Hg
32 mm Hg/time (s)
What are normal values for dP/dt for LV systolic function?
> 1,000 mmHg/s
What filter is used and what is bypassed to do tissue doppler imaging?
bypass the high velocity filters and turn on low velocity filters.
What frame rate is recommended for tissue doppler imaging?
Frame rate > 140/s
In TDI what is the wave profile during systole?
Biphasic wave during isovolumic contraction (IVCa and IVCb)
IVCa - MV closure and early myocardial activation at base moving myocardium inward and toward the apex
IVCb - Opposite direction after contraction of apex with base bulging up.
Finally a monophasic negative systolic (S) wave as myocardium moves inward and toward apex.
Are TDI velocities higher at the base of the LV or the Apex?
Higher velocities at the Base of heart with gradient to lower at the Apex.
What is a normal LV systolic velocity?
> 7.5 cm/s
What is curved M mode?
Color TDI graphic representation of velocity against time. This is done along a ventricular wall placing “markers” at various points.
What does Doppler Strain correlate with?
What does Doppler strain rate correlate with?
Doppler Strain - LVEF
Doppler Strain Rate - rate of rise of LV pressure (dP/dt)
Why is strain analysis better than simple tissue doppler velocities?
Tethering does not affect accuracy.
What is the drawback of 2D speckle tracking?
LVEF and LV volumes affected in foreshortened longitudinal views or motion in and out of plane
What is MAPSE?
Mitral Annular plane systolic excursion.
Normal values for MAPSE?
What is a MAPSE < 8 mm associated with?
12-15 mm
< 8 mm is associated with LVEF < 50%
How is MAPSE measured?
TTE apical four chamber view by M-mode
not validated for TEE
What is TMAD?
How is it performed?
Mitral Valve Tissue Motion Annular Displacement
ME four chamber view
What is the measure of severe LV dyssynchrony?
delay of > 130 ms between systolic motion of the septum and posterior wall.
What degree of delay between septal to lateral wall predicts responders to CRT?
65 ms
What are the five main cardiomyopathy variants?
Septal HCM
Concentric HCM
Apical HCM
Dilated cardiomyopathy
Restrictive Cardiomyopathy
What is left ventricular noncompaction?
Left ventricular noncompaction is a heart (cardiac) muscle disorder that occurs when the lower left chamber of the heart (left ventricle), which helps the heart pump blood, does not develop correctly. Instead of the muscle being smooth and firm, the cardiac muscle in the left ventricle is thick and appears spongy.
Where is the MR jet directed typically when associated with SAM?
Eccentric and posteriorly directed.
What does the shape of the velocity profile in the LVOT indicate?
“Dagger-shaped” gradient across the LVOT may indicate SAM.
What are the main secondary causes of dilated cardiomyopathy?
Viruses, toxins (alcohol, chemo, heavy metals), autoimmune diseases, collagen vascular disorders, pheochromocytoma, Neuromuscular, mitochondrial, metabolic, endocrine disorders, nutritional deficiencies.
What is the mechanism for Takotsubo cardiomyopathy?
rapidly developing cardiomyopathy, typified by extensive myocardial stunning in the mid and apical segments of the LV. Associated with extreme stress and high levels of circulating sympathetic hormones.
Treatment for Takotsubo cardiomyopathy?
Cardiac support
Treat underlying cause of stress and control of the sympathomimetic imbalance.
Takotsubo cardiomyopathy more common in male or female?
Female.
Apical ballooning may indicate which cardiomyopathy?
Taqkotsubo disease.
What is a bright sparkling granular appearnace of the myocardium indicative of?
Amyloid
What are two main causes of concentric hypertrophy?
Aortic stenosis and systemic HTN
A septal “bounce” during early diastole may indicate what?
This is the pericardial knock indicating possible constrictive pericarditis
May see ventricular interdependence: septum moves toward LV during inspiration.
Where are most LV aneurysms? What typically causes these?
At the apex and predominantly a consequence of anterior myocardial infarctions.
