Test DAy Flashcards
What mitral annular velocity values (usually) indicate normal diastolic function?
- septal (E’) = ≤ 7
- lateral (E’) = ≤ 10
What are the first two parameters to check in the assessment of diastolic function?
- LA volume indexed (LAVI)
- Doppler Tissue Imaging –> E’ (septal and lateral)
*** if both normal then most likely normal diastolic function
What is an easy way to determine normal LA pressure when assessing Left Atrial Inflow or Pulmonary Vein Flow (PVF) in assessment of diastolic function?
S > D
- 85% have normal LA pressure
In the assessment of diastolic function:
- How is the valsalva response obtained/measured?
- What does it determine?
- How can the Valsalva maneuver help to distinguish between normal/pseudonormal?
- Continuously recording mitral inflow (PW doppler) for 10s during the straining phase of the maneuver
- whether restrictive LV filling is reversible or not
- decrease in E/A ratio of ≥ 50%, not caused by E and A velocities fusion, is highly specific for increased LV filling pressures (supporting presence of diastolic dysfunction)
***Continuous recording of mitral inflow during standardized Valsalva maneuever for 10s –> decrease in E/A ratio with straining, which is consistent with elevated LV filling pressures
What are the four principal measurements in assessing presence of diastolic function in a patient with normal LVEF?
- E/e’ ratio > 14
- e’ averaged between septal and lateral annulus
- Tissue Doppler velocity (medial and lateral annuli) - e’
- medial < 7 cm/s
- lateral < 10 cm/s
- Peak continuous wave TR velocity > 2.8 m/s
- LA volume index > 34 cc/m2
**diastolic dysfunction present if > 50% positive
***indeterminate if 50% positive
****nromal diastolic function if < 50% positive
Describe the initial step in the grading of diastolic dysfunction
(in patients with depressed LVEF’s and patients with myocardial disease and normal EF)?
- Transmitral Inflow ratio
- E/A ≤ 0.8 + E ≤ 50 cm/s
- –> normal LAP, Grade I DD
- if symptomatic –> consider CAD, or diastolic stress test
- E/A ≤ 0.8 + E ≤ 50 cm/s
- E/A ≤ 0.8 + E > 50 cm/s or E/A > 0.8 - < 2
- –> 3 criteria to be evaluated
- E/A ≥ 2
- –> increase LAP, Grade III DD
In assessment of the AV/Aorta which measurements should be measured:
- leading edge to leading edge
- inner edge to inner edge
- Leading-to-leading edge (during mid-systole)
- LVOT diameter
- Aortic valve annulus
- Inner-to-inner edge
- sinuses of Valsalva
- sinotubular junction
- ascending aorta
Describe the algorithm differentiating CP and Restrictive Cardiomyopathy?
Describe the parameters to evaluated in grading diastolic function for those with:
E/A ≤ 0.8 + E > 50 cm/s or E/A > 0.8 - < 2
- Average E/e’ > 14
- TR velocity > 2.8 m/s
- LAVI > 34 ml/m2
Describe the findings of Grade II diastolic dysfunction
- LV relaxation - impaired
- LAP - Elevated
- Mitral E/A ratio - > 0.8 - < 2
- Average E/e’ ratio - 10-14
- Peak TR velocity (m/s) - > 2.8
- LAVI - Increased
Describe the diastolic filling pattern?
Grade 2 diastolic dysfunction
Pseudonormal
Describe the second step in determining diastolic function grade when all 3 parameters are known?
- 2/3 or 3/3 positive –> increased LAP or Grade 2 diastolic dysfunction
- 2/3 or 3/3 negative –> normal LAP or Grade I diastolic dysfunction
Describe the second step in determining diastolic function grade when only 2 parameters are known?
- 2 positive –> increased LAP or Grade 2 diastolic dysfunction
- 1 positive/1 negative –> indeterminate
- 2 negative –> normal LAP or Grade I diastolic dysfunction
What are supportive findings of CP with mixed mitral medial e’ (6-8 cm/s) in assessment of CP vs. RC?
-
Annulus reversus
- Mitral lateral e’ < medial e’
- Most likely constriction if present
- Hepatic vein expiratory end-diastolic reversal velocity / forward flow velocity = > 0.8
- definitely constriction if present
