Podcast
Questions and Answers
What are the two major components intrinsic to the left ventricle during diastolic function?
What are the two major components intrinsic to the left ventricle during diastolic function?
Active Myocardial Relaxation and Passive chamber compliance vs. stiffness
Which phase of the cardiac cycle does active myocardial relaxation occur in?
Which phase of the cardiac cycle does active myocardial relaxation occur in?
Early diastole
What happens to the rate of LV pressure decrease with age?
What happens to the rate of LV pressure decrease with age?
It decreases, leading to impaired relaxation.
To what does passive compliance or stiffness refer?
To what does passive compliance or stiffness refer?
Signup and view all the answers
Is myocardial stiffening a consequence of impaired relaxation?
Is myocardial stiffening a consequence of impaired relaxation?
Signup and view all the answers
Does echocardiography measure myocardial relaxation and filling pressures?
Does echocardiography measure myocardial relaxation and filling pressures?
Signup and view all the answers
If systolic dysfunction is present, diastolic dysfunction will also always be present.
If systolic dysfunction is present, diastolic dysfunction will also always be present.
Signup and view all the answers
What is the formula for calculating Left Atrial Volume Index (LAVi)?
What is the formula for calculating Left Atrial Volume Index (LAVi)?
Signup and view all the answers
What are the ranges of severity for LAVi according to the ASE Guidelines?
What are the ranges of severity for LAVi according to the ASE Guidelines?
Signup and view all the answers
Which type of Doppler imaging should be used to assess mitral valve inflow?
Which type of Doppler imaging should be used to assess mitral valve inflow?
Signup and view all the answers
What size of sample volume (SV) should be used for mitral valve inflow assessment using PW Doppler?
What size of sample volume (SV) should be used for mitral valve inflow assessment using PW Doppler?
Signup and view all the answers
What is the recommended sweep speed for mitral valve inflow assessment using PW Doppler?
What is the recommended sweep speed for mitral valve inflow assessment using PW Doppler?
Signup and view all the answers
What is the primary advantage of using Tissue Doppler Imaging (TDI) to assess diastolic function?
What is the primary advantage of using Tissue Doppler Imaging (TDI) to assess diastolic function?
Signup and view all the answers
What is the primary purpose of using TDI of the MV Annulus (Mitral Valve Annulus)?
What is the primary purpose of using TDI of the MV Annulus (Mitral Valve Annulus)?
Signup and view all the answers
What two Doppler signals do you need in order to calculate E/e' ratio?
What two Doppler signals do you need in order to calculate E/e' ratio?
Signup and view all the answers
What can be estimated using the E/e' ratio?
What can be estimated using the E/e' ratio?
Signup and view all the answers
How can the pulmonary veins help in assessing diastolic function?
How can the pulmonary veins help in assessing diastolic function?
Signup and view all the answers
What are the three components of blood flow in the pulmonary veins?
What are the three components of blood flow in the pulmonary veins?
Signup and view all the answers
Which pulmonary vein flow velocity is generally higher in normal diastolic function?
Which pulmonary vein flow velocity is generally higher in normal diastolic function?
Signup and view all the answers
What is the equation for calculating RVSP (Right Ventricular Systolic Pressure)?
What is the equation for calculating RVSP (Right Ventricular Systolic Pressure)?
Signup and view all the answers
Is diastolic dysfunction the only reason for elevated pulmonary pressures?
Is diastolic dysfunction the only reason for elevated pulmonary pressures?
Signup and view all the answers
Does a higher TR velocity in isolation definitively indicate diastolic dysfunction?
Does a higher TR velocity in isolation definitively indicate diastolic dysfunction?
Signup and view all the answers
What are the typical characteristics associated with Normal Diastolic function?
What are the typical characteristics associated with Normal Diastolic function?
Signup and view all the answers
What are the typical characteristics associated with Grade 1 Diastolic Dysfunction?
What are the typical characteristics associated with Grade 1 Diastolic Dysfunction?
Signup and view all the answers
What are the typical characteristics associated with Grade 3 and 4 Diastolic Dysfunction?
What are the typical characteristics associated with Grade 3 and 4 Diastolic Dysfunction?
Signup and view all the answers
What is the diastolic function grade for a patient with the following parameters: E velocity: 1.1 m/s, A velocity: 0.9 m/s, Decel time: 180 ms, E/A ratio: 1.2, e' velocity: 0.06, E/e' ratio: 18, LA Index: 42 cc/m², TR velocity: 3.0 m/sec, Pulmonary veins: D > S?
What is the diastolic function grade for a patient with the following parameters: E velocity: 1.1 m/s, A velocity: 0.9 m/s, Decel time: 180 ms, E/A ratio: 1.2, e' velocity: 0.06, E/e' ratio: 18, LA Index: 42 cc/m², TR velocity: 3.0 m/sec, Pulmonary veins: D > S?
Signup and view all the answers
What is the diastolic function grade for a patient with the following parameters: E velocity: 0.7 m/s, A velocity: 0.6 m/s, Decel time: 175 ms, E/A ratio: 1.2, e' velocity: 0.10, E/e' ratio: 7, LA Index: 28 cc/m², TR velocity: 2.4 m/sec, Pulmonary veins: S > D?
What is the diastolic function grade for a patient with the following parameters: E velocity: 0.7 m/s, A velocity: 0.6 m/s, Decel time: 175 ms, E/A ratio: 1.2, e' velocity: 0.10, E/e' ratio: 7, LA Index: 28 cc/m², TR velocity: 2.4 m/sec, Pulmonary veins: S > D?
Signup and view all the answers
What is the diastolic function grade for a patient with the following parameters: E velocity: 0.6 m/s, A velocity: 0.5 m/s, Decel time: 186 ms, E/A ratio: 1.2, e' velocity: 0.08, E/e' ratio: 8, LA Index: 22 cc/m², TR velocity: 2.2 m/sec, Pulmonary veins: S > D?
What is the diastolic function grade for a patient with the following parameters: E velocity: 0.6 m/s, A velocity: 0.5 m/s, Decel time: 186 ms, E/A ratio: 1.2, e' velocity: 0.08, E/e' ratio: 8, LA Index: 22 cc/m², TR velocity: 2.2 m/sec, Pulmonary veins: S > D?
Signup and view all the answers
What is the diastolic function grade for a patient with the following parameters: E velocity: 1.2 m/s, A velocity: 0.5 m/s, Decel time: 140 ms, E/A ratio: 2.4, e' velocity: 0.03, E/e' ratio: 40, LA Index: 50 cc/m², TR velocity: 3.6 m/sec, Pulmonary veins: D > S?
What is the diastolic function grade for a patient with the following parameters: E velocity: 1.2 m/s, A velocity: 0.5 m/s, Decel time: 140 ms, E/A ratio: 2.4, e' velocity: 0.03, E/e' ratio: 40, LA Index: 50 cc/m², TR velocity: 3.6 m/sec, Pulmonary veins: D > S?
Signup and view all the answers
What is the Average E/e' ratio for a patient with the following parameters: Septal e': 5 cm/s (.05 m/s) and Lateral e': 8 cm/s (.08 m/s).
What is the Average E/e' ratio for a patient with the following parameters: Septal e': 5 cm/s (.05 m/s) and Lateral e': 8 cm/s (.08 m/s).
Signup and view all the answers
What is the RVSP for a patient with a TR velocity of 3.6 m/s and an assumed right atrial pressure (RAP) of 10 mmHg?
What is the RVSP for a patient with a TR velocity of 3.6 m/s and an assumed right atrial pressure (RAP) of 10 mmHg?
Signup and view all the answers
Study Notes
Normal vs Abnormal Diastolic Function
- Normal function: The heart fills to a normal end-diastolic volume without increasing end-diastolic filling pressure, both at rest and with exertion.
- Abnormal function: The heart is unable to fill to the normal volume needed for an adequate stroke volume without an abnormal increase in filling pressures.
Components of Diastolic Function
- Two main components of left ventricle function:
- Active myocardial relaxation
- Passive chamber compliance/stiffness
Active Relaxation
- Energy-dependent process in early diastole.
- Involves early, rapid filling and a decrease in left ventricle (LV) pressure.
- Faster decrease correlates to better relaxation (younger hearts), slower decrease indicates impaired relaxation (occurs with age).
Passive Compliance/Stiffness
- Refers to how readily the left ventricle accepts blood flow.
- Occurs during filling (early filling, diastasis, and atrial contraction)
- A compliant ventricle allows blood flow without a significant pressure increase ("sucks blood in").
- A stiff ventricle demands a larger increase in pressure to increase ventricular volume ("pushes blood in").
Key Points about Diastolic Function
- Myocardial relaxation is often abnormal in patients with diastolic dysfunction.
- Myocardial stiffness (non-compliance) results in increased filling pressures.
- Echocardiography measures myocardial relaxation and filling pressure.
- Systolic dysfunction often accompanies diastolic dysfunction.
Echo Assessment of Diastolic Function
- Left atrial volume index
- Mitral valve inflow
- Pulmonary vein flow
- Tissue Doppler imaging
- Pulmonary pressures
Left Atrial Volume Index
- Measurement reflects left atrial volume relative to body surface area (BSA).
- Left atrial pressure increases to fill a noncompliant left ventricle, causing left atrial enlargement.
- Ranges of severity based on values (in cc/m²) categorize normality/enlargement.
Mitral Inflow / PW Doppler
- Small sample volume (1-3 mm) is optimal
- Optimize scale and baseline
- Low filter/gain settings ideal
- Sweep speed: 100 mm/s
- Align parallel to flow
MV Inflow
- Measures key parameters: E velocity, A velocity, E/A ratio, Deceleration Time (DT), and A duration
- E wave: peak velocity during early filling.
- A wave: peak velocity during atrial contraction.
- E/A ratio: ratio of E wave velocity to A wave velocity.
- DT: time for peak velocity to reach zero during early filling.
- A duration: duration of the A wave.
Mitral Valve Inflow: E and A waves
- E wave: Peak velocity of early ventricle filling.
- A wave: Peak velocity of atrial contraction.
Mitral Valve Inflow: Deceleration Time
- Deceleration time (DT) measures the time from peak early filling velocity to zero baseline.
- Influenced by LV relaxation, filling pressures, and LV compliance.
- Normal DT: 150-200 ms.
- Grade 1 diastolic dysfunction: DT >200 ms
- Grade 3 diastolic dysfunction: DT < 150 ms
Question:
- Impact of Grade 1 diastolic dysfunction on deceleration time is longer DT than normal.
- Impact of Grade 3 diastolic dysfunction on deceleration time is shorter DT than normal.
- Impact of Grade 1 pattern on E/A ratio compared to normal diastolic function is decreased E/A ratio.
- Impact of Grade 3 pattern on E/A ratio compared to normal diastolic function is increased E/A ratio.
Mitral Valve Inflow: Diastasis
- The diastasis is a slow filling phase occurring between E and A waves.
- In normal settings, this flow is less than 0.2 m/s.
- Increased filling pressure may increase flow during diastasis
Question:
- Effect of faster HR on diastasis is decreased diastasis.
Question:
- Doppler signals needed to calculate E/e' ratio are E wave velocity and e' wave velocity.
Tissue Doppler Imaging of the MV Annulus
- Movement of the mitral valve annulus reflects properties of heart relaxation.
- Not affected by preload.
- Helpful in determining filling pressures
- Procedure involves use of apical four-chamber view, larger sample volume, precise cursor alignment to highest annulus "bounce", measurements from both medial and lateral MV annulus.
Tissue Doppler Imaging
- Adjusts Doppler signal to measure tissue mobility, not blood flow.
- Tissue velocities are lower than blood flow velocities.
- Angle dependence is an important factor when taking measurements.
- Procedure involves use of apical four-chamber view, larger sample volume, precise cursor alignment to highest annulus "bounce," measurements from both medial and lateral MV annulus.
- Measurements of s', e', and a' are taken when obtaining images of diastolic function.
- Normal e' velocity (medial): > 0.10 m/s; (lateral): > 0.13 m/s.
- Normal E/e' ratio: <8.
E/e' Ratio
- Calculated by dividing the mitral E wave by e' velocity (tissue Doppler)
- Used to estimate left atrial pressure (LAP).
Pulmonary Veins
- Left atrium fills from pulmonary veins.
- Three components to pulmonary vein flow:
- Systolic forward flow
- Diastolic forward flow (early diastole)
- Atrial reversal of flow (atrial contraction)
Pulmonary Veins (PW Doppler)
- Sample volume (3-5 mm) is placed approximately 1cm into pulmonary vein.
- Optimize scale and baseline.
- Use low filters and gain settings.
- Sweep speed: 100 mm/s.
- Systolic flow velocity (S) is typically slightly higher than diastolic flow velocity (D) in normal diastolic function.
- If two systolic components exist (S1, S2), measure S2 velocity.
Pulmonary Pressures
- Left ventricular diastolic dysfunction leads to increased pulmonary pressures.
- Right ventricular systolic pressure (RVSP) = 4 (tricuspid regurgitation velocity)2 + right atrial pressure (RAP).
Right Heart/Pulmonary Pressures
- TR velocity and IVC assessment
- 4 (VTR)2 + RAP
- Significant diastolic dysfunction results in elevated pulmonary pressure (TR velocity > 2.8 m/s)
- Diastolic dysfunction is not the sole explanation for elevated pulmonary pressures.
Normal Diastolic Function, Grade 1: Summary Table
- Mitral Valve (characteristics): E < A, E/A ratio < 0.8, Decel Time > 200 ms
- Tissue Doppler MV Annulus (characteristics): e' velocity ≥0.08 m/s, E/e' ratio < 8
- Pulmonary Veins (characteristics): Systolic > diastolic, Small atrial reversal
- LA index is normal
- TR velocity < 2.8 m/sec
Normal Diastolic Function: Summary Table (practice)
- General: LA function is normal; TR velocity is less than 2.8 m/sec
Grade 1 Diastolic Dysfunction, Summary Table
- Mitral Valve: E < A, E/A ratio < 0.8, Deccel time > 200 ms
- Tissue Doppler MV Annulus: e' velocity ≥0.08 m/s, E/e' ratio <8 (possibly in indeterminate range 8-14).
- Pulmonary Veins: Systolic > diastolic, small atrial reversal.
- LA index is normal/mildly enlarged
- TR velocity < 2.8 m/sec
Grade 2 Diastolic Dysfunction, Summary Table
- Mitral Valve: E > A, E/A ratio < 1.0-1.5, Decel time 150-200 ms
- Tissue Doppler MV Annulus: e' velocity < 0.07 m/sec, E/e' ratio ≥ 14
- Pulmonary Veins: Systolic < diastolic; Larger atrial reversal.
- LA index enlarged
- TR velocity > 2.8 m/sec
Grade 3 and 4 Diastolic Dysfunction, Summary Table
- Mitral Valve: E > A, E/A ratio > 2, Decel time < 150 ms
- Tissue Doppler MV Annulus: e' and velocity < 0.07 m/sec; E/e' ratio ≥ 14 (often significantly high)
- Pulmonary Veins: Systolic < Diastolic, Blunted systolic or diastolic; Large atrial reversal.
- LA index: severely enlarged
- TR velocity > 2.8 m/sec
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Related Documents
Description
This quiz explores the differences between normal and abnormal diastolic function of the heart. It covers components like active myocardial relaxation and passive chamber compliance. Understand how these factors affect heart performance during various states.
