Tissue Doppler Flashcards
What angle do you want to keep tissue doppler within?
<20 degrees
Tissue doppler should be averaged over how many cardiac cycles?
3
What e’ on the lateral mitral annulus work indicate that they have Grade 0 (Normal)?
Lateral e’ velocity of > 10 cm/sec
If the e’ (lateral mitral TDI) is <10 cm, what determines Grade 1 impaired relaxation?
E/e’ <8
If the e’ (lateral mitral TDI) is <10 cm, what determines Grade 2 pseudonormal?
E/e’ = 9-12
If the e’ (lateral mitral TDI) is <10 cm, what determines Grade 3 Restrictive?
E/e’ > 13
In the ME 4 chamber, how does the septal annulus move during systole? during diastole
Moves down = Systole
Moves up = Diastole (What we measure)
During tissue doppler, what are the main 3 waves we look at?
Draw these waves
S’ = Peak velocity during systole
e’ = Peak early velocity diastole
a’ = Peak late velocity diastole
What is the myocardial performance index?
IVCT + IVRT / ET
Isovolumetric contraction time
Isovolumetric relaxation time
Ejection TIme
What is a concerning lateral mitral annulus e’ wave?
<8 cm/sec = Bad
Which mitral annulus has a greater velocity?
What is the caveat?
lateral > septal
Caveat = CP in which lateral e’ < septal e’
What is a non-reassuring e’ velocity?
e’ < 8 cm/sec = bad
What is a reassuring a’ velocity?
a’ <10 = Good
what is a non-reassuring e’/a’ ratio?
<1 = bad
What are the 3 important time intervals needed to know for TDI?
- Isovolumetric Contraction
- Ejection Time
- Isovolumetric Relaxation
What is a reassuring s’ velocity?
s’ > 8 cm/sec = good
What is a non-reassuring s’ velocity?
s’ < 5 cm/sec = bad
What is the Te’?
What is the significance for diastole?
Time to e’
Onset of QRS to onset of e’ wave
For diastole = Prolonged Te’ in diastolic dysfunction
What is Te?
Time from QRS (R wave) to E wave (Transmitral inflow velocities)
What is the significance of substracting Te’ - E
Te’ - TE = Prolonged with impaired relaxation and is strongly dependence on tau = Time constant of LV relaxation
What is a normal Te’ - TE measurement?
0 - 4 msec
When is Te’ - TE unreliable?
Arrythmias
Variable HR
Atrial Fibrillation
How does the s’ in TDI change in ischemia?
Decreased
How does the e’ in TDI change in ischemia?
Decreased
How does the a’ in TDI change in ischemia?
Increased
How does the e’/a ratio in TDI change in ischemia?
Decrease
what are the limitations to tissue doppler limitations?
Mitral annular disease / tethering
What is tissue doppler in cardiac tamponade?
Normal
What is tissue doppler in constrictive pericarditis?
Normal
What is annular reversus?
Lateral e’ < septal e’
1.24 - 1.3 = Normal ratio, but in this disease, its <0.95!
What is the lateral e’ in RICM?
e’ < 8 cm/sec
What is the lateral e’ in CP?
e’ >10 cm/sec
MPI is a measure of what function:
Systolic or Diastolic?
BOTH!
Systolic and Diastolic
What is the formula for MCI?
Isovolemic phases / Ejection Time
[IVCT + IVRT] / ET
What is the value for MPI?
0.39 +/- 0.05 = Normal
“Low number is better”
Ex: Dilated CM has 0.59 +/- 0.1
What S’ for the Tricuspid lateral annulus is non-reassuring when assessing right heart function?
Right ventricle S’ <10 cm/sec
(This would be concerning in young healthy patient)
What is the formula for Isovolumetric acceleration?
Vt / Change in time
Vt = Max Isovolumetric Velocity
Change in time = Time it takes to get there
Is the RV MPI independent or dependent on loading conditions?
RV MPI independent of HR, preload and afterload
What is the normal values for IVA?
1.4 +/- 0.5 m/s2
Is the RV MPI measure systolic or diastolic function?
Both
What is the formula for MPI?
IVCT + IVRT / ET
What RV MPI value was found to be predictive of HD instability and mortality after cardiac valvular surgery?
> 0.5
What is the formula for RV strain?
Straing = [Final Length - Initial Length] / Initial length
L2 - L1
What is a normal RV strain?
Anymore more negative than -20
What is the strain rate?
Strain / Change in time
(V2-V1) / x
