Ventricular Diastolic Function

Question 1

What are the 4 phases of diastole?

Answer 1

Initial isovolumic relaxation

Early rapid LV inflow

Diastasis

Atrial systole.

Question 2

What is the E/A for impaired relaxation?

What is the IVRT?

Answer 2

E/A < 0.8

IVRT > 110 ms

Question 3

What is the E/A in a pseudonormal filling pattern?

What will be abnormal?

Answer 3

normal with 0.8

E/e’ > 10-14

Question 4

What happens to pulmonary venous flow in a restrictive diastolic dysfunction pattern?

Answer 4

Systolic blunting.

Question 5

How to assess diastolic function in atrial fibrillation?

Answer 5

Average 10 consecutive cycles.

Question 6

What happens to diastolic assessement in patients with Mitral annular calcification?

Answer 6

E/e’ measurements may be elevated.

E/A and IVRT better correlate

Question 7

What happens to diastolic assessement in patients with mitral stenosis?

Answer 7

E/e’, etc are unreliable metrics.

Question 8

What does end systole hepatic flow reversal indicate for right ventricular compliance?

Answer 8

Decreased

Question 9

In tamponade does RA or RV collapse happen first? To what extent is RA collapsed?

Answer 9

RA collapse is first

Happens in early systole and lasts more than 1/3 of the cardiac cycle.

With further rise of pressures then RV collapses.

Question 10

What is the L wave in diastology?

Answer 10

In pseudonormal diastolic pattern

Question 11

What is a normal septal e’?

Normal lateral e’?

Answer 11

Septal = 8 cm/s

Lateral = 12 cm/s

Question 12

Explain the parts of the pulmonary vein waveform.

Answer 12

S1 - Atrial relaxation

S2 - Descent of ventricular base “sucks” blood into atrium

D: blood passively flows into atrium during ventricular diastole

A: Reversal wave - reflux when atria contracts

Question 13

What A reversal wave velocity suggests elevated LVEDP?

Answer 13

Velocity > 35 cm/s

Question 14

What happens to IVRT (Isovolumetric Relaxation Time) in an impaired relaxation, pseudonormal, and Restrictive Diastolic patterns?

Answer 14

Impaired relaxation - IVRT increased

Decreases for other two

Question 15

What happens to A duration (Atrial kick) for impaired relaxation, pseudonormal, and restrictive diastolic patterns?

Answer 15

Impaired relaxation - Increased A duration

Decreased in other 2

Question 16

What does an E/Vp >2.5 mean for PCWP?

Vp = propogation velocity

Answer 16

> 15 mmHg in patients with decreased LVEF

Question 17

How to calculate Myocardial performance Index?

Answer 17

(IVCT + IVRT)/ET

IVCT = Isovolumic contraction time

IVRT = Isovolumic relaxation time

ET = Ejection Time

Question 18

What is a typical pulmonary venous doppler flow profile?

Answer 18

antegrade systolic velocity which may be monophasic or biphasic ( PVs1, PVs2)

This is followed by an antegrade diastolic flow while mitral valve is open.

Finally a late diastolic flow reversal PVar

Question 19

What is a normal pulmonary venous diastolic atrial flow reversal duration?

Answer 19

90-115 ms

Question 20

What happens to the pulmonary venous waveform in a patient with an impaired relaxation pattern?

Answer 20

Reduced PVd velocity and compensatory increase in PVs resulting in a systolic predominance.

Question 21

What happens to the pulmonary venous waveform in a restrictive filling pattern?

Answer 21

Systolic blunting as well as an increase in duration and velocity of the late diastolic flow reversal PVar