Diastology

Question 1

simplified algorithm for determining diastolic function

Answer 1

e’ velocity > 10 then normal

If less than 10 then use E/e’
E/e’ <8 grade 1
E/e’ 9-12 grade 2
E/e’ >13 grade 3

Question 2

4 phases of diastole

Answer 2

isovolemic relaxation, early filling, diastasis, late filling (atrial contraction)

Question 3

transmitral inflow

Answer 3

two main mechanisms = active relaxation and LV compliance

Active relaxation- uses ATP to suck or pull blood into it

LV compliance- decrease compliance equals increased LAP and earlier opening and decreased deceleration time and smaller a wave

Question 4

What is responsible for changes between grade 1 and 3 diastolic dysfunction when relaxation is impaired in all?

Answer 4

Decreased compliance and increase in LAP

Question 5

A S1 S2 and D wave contributors on pulm vein flow

Answer 5

A - atrial contraction , retrograde flow into pulm vein
S1 - atrial relaxation
S2 - RV stroke volume, descent of annulus
D - mitral valve opens and allows early filling

Question 6

S wave and D wave correlations
LAP waveform

Answer 6

S = x descent
D = y descent

Question 7

How is A reversal wave on pulm vein different in grade 2 and 3 diastolic dysfunction

Answer 7

Longer in time than A wave mitral inflow. Higher velocity

Question 8

limitations of pulmonary venous inflow

Answer 8

MR, MS, arrythmias, heart rate, loading conditions

Question 9

how will valsalva change pseudonormal pattern on mitral inflow

Answer 9

change it to grade 1 with decrease in preload

Question 10

Propagation velocity Vp

Answer 10

Normal >50 cm/s
4 cm into LV
Load dependent, increases with increases in preload
E/Vp >2.5 predicts >15 PCWP if LVEF is reduced

Question 11

Tissue doppler

Answer 11

High amplitude , low velocity signals
s’ , e’, a’
Angle dependent (keep it less than 20)
Load independent with diastolic dysfunction
avg over 3 cardiac cycles

Question 12

TDI e’

Answer 12

less than 8 is bad
greater than 10 normal
e’/a’ less than 1 is bad, independent of angle

Question 13

E/e’

Answer 13

> 13 used for patients with normal for grade 3
15 used for patients that are dysfunctional for grade 3

Question 14

VP limitations

Answer 14

hard to reproduce
preload dependent

Question 15

tissue doppler

Answer 15

best modality to measure diastolic function
angle dependent, average over 3 cardiac cycles
Load independent if you have diastolic dysfunction

Te’ prolonged with impaired relaxation
Te’-e prolonged with impaired relaxation

Question 16

limitations of tissue doppler

Answer 16

mitral annular disease/tethering
time intervals require regular rhythm and stable hr
normal patients are preload dependent
regional wall motion abnormalities
angle dependent

Question 17

tamponade transmitral inflow

Answer 17

impaired relaxation pattern
lateral mitral normal tissue doppler

Question 18

constrictive pericarditis inflow

Answer 18

restrictive pattern
lateral mitral normal tissue doppler

Question 19

Estimating filling pressure

Answer 19

E/E’ >15
IVRT/Te’-e <2
E/Vp >2.5 if LVEF reduced
Ardur-Adur >30 ms

Question 20

ardur-adur

Answer 20

pulmonary venous a wave duration - mitral inflow a duration

Question 21

Diastolic dysfunction

Answer 21

All forms have impaired LV relaxation

LAP elevated in grade 2 and 3

E/A ratio<0.8 grade 1, E/A >2 grade 3, between is either normal or grade 2

average E/e’ <10 grade 1, 10-14 grade 2, >14 grade 3

Peak TR V >2.8 in grade 2 and 3

LA volume index >34ml/m2 in grade 2 and 3

Question 22

patients with normal ef

Answer 22

E/e’ >14
lateral e’< 10
TR velocity >2.8
La vol index >34

2/4 inderminate
3-4 diastolic dysfunction
0-1 normal

Question 23

E/A and e’ changes with age

Answer 23

E/A increases and e’ decreases

Question 24

4 variables recommended by 2016 evaluation of diastolic function

Answer 24

e’
E/e’
LA max volume index
TR peak velocity

Question 25

How does Ar and A duration indicate elevated LAP

Answer 25

when PV Ar duration > Mitral A duration by 30 msec

Question 26

S/D pulmonary venous ratio changes in diastolic dysfunction

Answer 26

less than 1 when LAP is high