LVAD / CRT

Question 1

Shunts in LVAD

Answer 1

Left to right shunts reverse

Question 2

Valve disease in LVAD

Answer 2

AR and TR worsen

MR gets better

Question 3

Max peak systolic velocity for LVAD cannulas

Answer 3

1.5 m/s

Question 4

CRT optimization

Answer 4

Optimize diastolic filling
Achieve normal or grade 1 DD
Cannot optimize in AF

Question 5

AV dyssynchrony quant

Answer 5

left ventricular filling time <=40%

Question 6

Interventricular dyssynchrony

Answer 6

IVMD >= 40 ms

Question 7

Interventricular mechanical dyssynchrony index

Answer 7

Time delay between onset of RV and LV ejections

Question 8

LV dyssynchrony M-mode

Answer 8

Time delay between systolic inward motion of septum and posterior wall >130 ms (septal-posterior wall motion delay index SPWMD)

Question 9

Prolonged AV conduction transmitral doppler

Answer 9

Fusion of E and A waves

Question 10

LV dyssynchrony TDI

Answer 10

Calculate time delay between peak systolic velocities of two or four opposing walls

Question 11

LV dyssynchrony color TDI predictors of CRT response

Answer 11

Time delay in peak systolic velocity between basal septal and basal lateral walls >= 60 ms
4 Opposing wall delay of >=65 ms predicts favorable response

Question 12

TDI strain rate for LV dyssynchrony characteristics

Answer 12

Myocardial deformation
Dependent on angle
Can distinguish active contraction from scar
Time delay >= 130ms between anteroseptal and posterior walls on radial strain-time curves predicts improvement after CRT

Question 13

3D LV dyssynchrony

Answer 13

Direct volumetric analysis or triplane TSI analysis

Question 14

3D SDI response

Answer 14

> 9.8% predicts response to CRT

Question 15

3D triplane TSI

Answer 15

Time to peak systolic velocity in basal and mid ventricular segments

Question 16

3D SD time to peak velocity response

Answer 16

> =33 ms predicts response to CRT

Question 17

3D SDI

Answer 17

Standard deviation of time to minimum regional systolic volume for 16 segments (systolic dyssynchrony index SDI)

Question 18

Optimal A-V delay

Answer 18

Shortest AV interval without compromising A wave

Question 19

AV delay too short

Answer 19

Truncation of A wave, LVFT lengthens, MV closes prematurely

Question 20

Method to optimize AV delay

Answer 20

PW doppler of transmitral flow

Question 21

Optimize inter ventricular (VV) delay

Answer 21

Measurement to VTI on PW doppler of LVOT

Evaluation of LV dyssynchrony on color-coded TDI by measuring septal-to-lateral peak systolic velocity-time delay

Question 22

AV delay too long

Answer 22

E-A fused, short LVFT

Question 23

Iterative method for AV optimization

Answer 23

Start with long AV delay, shorten by 20 ms steps until A wave is truncated, then lengthen in 10 ms steps until A wave no longer truncated

Question 24

Indicators of at least moderate AR prior to LVAD

Answer 24

Vena contracta >= 0.3 at nyquist 50-60

Jet width / LVOT width > 46%