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PTE Masters + A Practical Approach to Transesophageal Echocardiography > Tissue Doppler > Flashcards

Tissue Doppler Flashcards

1
Q

What angle do you want to keep tissue doppler within?

A

<20 degrees

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2
Q

Tissue doppler should be averaged over how many cardiac cycles?

A

3

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3
Q

What e’ on the lateral mitral annulus work indicate that they have Grade 0 (Normal)?

A

Lateral e’ velocity of > 10 cm/sec

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4
Q

If the e’ (lateral mitral TDI) is <10 cm, what determines Grade 1 impaired relaxation?

A

E/e’ <8

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5
Q

If the e’ (lateral mitral TDI) is <10 cm, what determines Grade 2 pseudonormal?

A

E/e’ = 9-12

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6
Q

If the e’ (lateral mitral TDI) is <10 cm, what determines Grade 3 Restrictive?

A

E/e’ > 13

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7
Q

In the ME 4 chamber, how does the septal annulus move during systole? during diastole

A

Moves down = Systole

Moves up = Diastole (What we measure)

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8
Q

During tissue doppler, what are the main 3 waves we look at?

Draw these waves

A

S’ = Peak velocity during systole

e’ = Peak early velocity diastole

a’ = Peak late velocity diastole

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9
Q

What is the myocardial performance index?

A

IVCT + IVRT / ET

Isovolumetric contraction time

Isovolumetric relaxation time

Ejection TIme

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10
Q

What is a concerning lateral mitral annulus e’ wave?

A

<8 cm/sec = Bad

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11
Q

Which mitral annulus has a greater velocity?

What is the caveat?

A

lateral > septal

Caveat = CP in which lateral e’ < septal e’

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12
Q

What is a non-reassuring e’ velocity?

A

e’ < 8 cm/sec = bad

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13
Q

What is a reassuring a’ velocity?

A

a’ <10 = Good

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14
Q

what is a non-reassuring e’/a’ ratio?

A

<1 = bad

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15
Q

What are the 3 important time intervals needed to know for TDI?

A
  1. Isovolumetric Contraction
  2. Ejection Time
  3. Isovolumetric Relaxation
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16
Q

What is a reassuring s’ velocity?

A

s’ > 8 cm/sec = good

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17
Q

What is a non-reassuring s’ velocity?

A

s’ < 5 cm/sec = bad

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18
Q

What is the Te’?

What is the significance for diastole?

A

Time to e’

Onset of QRS to onset of e’ wave

For diastole = Prolonged Te’ in diastolic dysfunction

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19
Q

What is Te?

A

Time from QRS (R wave) to E wave (Transmitral inflow velocities)

20
Q

What is the significance of substracting Te’ - E

A

Te’ - TE = Prolonged with impaired relaxation and is strongly dependence on tau = Time constant of LV relaxation

21
Q

What is a normal Te’ - TE measurement?

A

0 - 4 msec

22
Q

When is Te’ - TE unreliable?

A

Arrythmias

Variable HR

Atrial Fibrillation

23
Q

How does the s’ in TDI change in ischemia?

A

Decreased

24
Q

How does the e’ in TDI change in ischemia?

A

Decreased

25
Q

How does the a’ in TDI change in ischemia?

A

Increased

26
Q

How does the e’/a ratio in TDI change in ischemia?

A

Decrease

27
Q

what are the limitations to tissue doppler limitations?

A

Mitral annular disease / tethering

28
Q

What is tissue doppler in cardiac tamponade?

A

Normal

29
Q

What is tissue doppler in constrictive pericarditis?

A

Normal

30
Q

What is annular reversus?

A

Lateral e’ < septal e’

1.24 - 1.3 = Normal ratio, but in this disease, its <0.95!

31
Q

What is the lateral e’ in RICM?

A

e’ < 8 cm/sec

32
Q

What is the lateral e’ in CP?

A

e’ >10 cm/sec

33
Q

MPI is a measure of what function:

Systolic or Diastolic?

A

BOTH!

Systolic and Diastolic

34
Q

What is the formula for MCI?

A

Isovolemic phases / Ejection Time

[IVCT + IVRT] / ET

35
Q

What is the value for MPI?

A

0.39 +/- 0.05 = Normal

“Low number is better”

Ex: Dilated CM has 0.59 +/- 0.1

36
Q

What S’ for the Tricuspid lateral annulus is non-reassuring when assessing right heart function?

A

Right ventricle S’ <10 cm/sec

(This would be concerning in young healthy patient)

37
Q

What is the formula for Isovolumetric acceleration?

A

Vt / Change in time

Vt = Max Isovolumetric Velocity

Change in time = Time it takes to get there

38
Q

Is the RV MPI independent or dependent on loading conditions?

A

RV MPI independent of HR, preload and afterload

39
Q

What is the normal values for IVA?

A

1.4 +/- 0.5 m/s2

40
Q

Is the RV MPI measure systolic or diastolic function?

A

Both

41
Q

What is the formula for MPI?

A

IVCT + IVRT / ET

42
Q

What RV MPI value was found to be predictive of HD instability and mortality after cardiac valvular surgery?

A

> 0.5

43
Q

What is the formula for RV strain?

A

Straing = [Final Length - Initial Length] / Initial length

L2 - L1

44
Q

What is a normal RV strain?

A

Anymore more negative than -20

45
Q

What is the strain rate?

A

Strain / Change in time

(V2-V1) / x

PTE Masters + A Practical Approach to Transesophageal Echocardiography (55 decks)

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