Diastolic Function Assessment - Asecho
1/9/2018Diastolic Function AssessmentPractical Ways to Incorporate into Every EchoJae K. Oh, MDEcho Hawaii 2018 2018 MFMER 3712003-1Learning ObjectivesMy presentation will help you to Appreciate the importance of myocardial relaxation for satisfactorydiastolic function Assess and Grade diastolic function Estimate LV filling pressure noninvasively Incorporate Diastolic Function assessment into every Echo Apply Diastolic Function Assessment in Diagnosis of HFpEF Exercise Diastolic Test Restrictive CM vs Constriction 2018 MFMER 3712003-21
1/9/2018Cardiac FunctionSystole and Diastole (διαστολή)διαστολή: Greek word for dilationFillingPumpingNormal diastolic function allows adequate filling of the heartwithout excessive increase in diastolic filling pressure at rest andwith stress 2018 MFMER 3712003-3Diastolic Filling with Relaxation 2018 MFMER 3712003-42
1/9/2018Diastolic Filling PatternsTransmitral Gradient vs Mitral Inflow1/9/2018 2018 MFMER 3712003-5LV Relaxation by Cath and Echo (tau) vs e’ (mitral annulus velocity)120tau (msec)100y -6.80x 85.68r 0.70P 0.0018060402000246e’ (cm/sec)81012Firstenberg et al: J Appl Physiol 90:299, 2001, Nagueh et al: JACC 1997Oki et al: AJC 1997 , Sohn et al:JACC 1997, Ommen et al: Circ 2000 2018 MFMER 3712003-63
1/9/2018Which of following patients has the most advanceddiastolic dysfunction (or impaired relaxation)?123 2018 MFMER 3712003-7Myocardial Relaxation (e’)e’ 12 cm/sece’ 7 cm/sece’ 3 cm/sec 2018 MFMER 3712003-84
1/9/2018Evaluation of Diastolic FunctionMitral Inflow and Annulus VelocityNormalAb RelaxGrade 1PseudoGrade 2RestrictiveGrade 3Mitral flowPreload dependentMitral annulusvelocityPreload independentSohn et al: JACC, 1997CP1254003-30 2018 MFMER 3712003-9Estimation of LV Filling PressuresE/e’ (Medial MV annulus)40LV filling pressure3530EF 50%EF 50%2520151050E/E 8E/E 8-15E/E 15Ommen SR et al: Circulation 102:1788, 2000 2018 MFMER 3712003-105
1/9/2018Four Major Parameters in DiastologyNormal valuesFour Major Diagnostic ParametersNormal Values1. E’ velocity 7(med), 10 (lat) cm/s2. E/e’ 14 (Ave), 15(Med)3. TR velocity 2.8 m/sec4. LAVI 34 mL/m2JASE and EJ CV Imaging April 2016 2018 MFMER 3712003-11New Criteria for Diastolic Function AssessmentIn pts with normal LVEF 50%1 – Septal e’ velocity 7 cm/s orlateral e′ velocity 10 cm/s2 – Average E/e′ 14 , 15 (Med)3 – TR velocity 2.8 m/s4 – LA volume index 34 mL/m2 3 Normal2 and 2 3 AbnormalNormal diastolic functionIndeterminateDiastolic dysfunction 2018 MFMER 3712003-126
1/9/201871 year old woman with HR 45 BPM &LAVI 39 mL/m2E/e’E’LAVITRNL 14NL 7EnlargedNL 2.8Lateral e’ 10 cm/secMedial e’ 9 cm/secLVOT TVI 30 cmE/e’ 9E/e’ 10 2018 MFMER 3712003-13ӿ E’ӿ E/e’ӿ LAVIӿ TR vel.67 year old man with HFE 100 A 30 cm/secE/A 3.3e’ 5 cm/secE/e’ 20 2018 MFMER 3712003-147
1/9/2018Mitral inflowE/A 0.8 E 50cm/sE/A 2E/A 0.8 E 50 cm/sorE/A 0.8- 23 criteria to be evaluated*2 of 3negative1 – Average E/e′ 142 – TR velocity 2.8 m/s3 – LA volume index 34 mL/m22 of 3 or3 of 3positiveWhen only 2 criteria are available2 negativeNormal LAPGrade I diastolicdysfunction1 positive and1 negative2 positiveCannot determine LAP anddiastolic dysfunctiongrade*If symptomatic considerCAD or proceed todiastolic stress test LAPGrade II diastolicdysfunction LAPGrade III diastolicdysfunctionIn patients with depressed LVEFor normal EF with diastolic dysfunction 2018 MFMER 3712003-1567 year old man with HFGR 3 Diastolic Dysfunction with Severe Increase in Filling PressureE 100 A 30 cm/secE/A 3.3e’ 5 cm/secE/e’ 20 2018 MFMER 3712003-168
1/9/201867 yo man with ischemic CM and HFGr. 1 dysfunction normal filling pressureE 45 cm/sec A 90 cm/secE 45 cm/s A 90 cm/sE/A 0.5E/A 0.5Grade 1 DysfunctionE/A 0.8E 50 cm/sec 2018 MFMER 3712003-1767 year old man with ischemic CM and HFE 45 cm/s E/A 0.5E/e’ 12Medial e’ 4 cm/s2 months beforeE 120 cm/sec E/A 1.0E/e’ 30TR Vel 3 m/sec 2018 MFMER 3712003-189
1/9/2018Ischemic Cardiomyopathy Echo PredictorSTICH Trial (N 1511)Best survival with E/A 0.5-0.8 2018 MFMER 3712003-19Case # 2 ARSGrade the diastolic function of23 YO male with HCM1. Grade 12. Grade 23. Grade 34. Possibly normalE 70 cm/s A 30 cm/sE/A 2.3 2018 MFMER 3712003-2010
1/9/2018E 70 cm/s23 yo with HCMMedial e’ 8 cm/secE/e’ 9Lateral e’ 10 cm/secE/e’ 7Can he have a normal diastolic function ? 2018 MFMER 3712003-2123 yo man with HCMLAVI 29 mL/m2TR 2 m/secIVRT 120 msec 2018 MFMER 3712003-2211
1/9/2018Valsalva in 23 yo HCMNormal filling pressureE/A 2.3E/A 2.0 2018 MFMER 3712003-23Mitral inflowE/A 0.8 E 50cm/sE/A 2E/A 0.8 E 50 cm/sorE/A 0.8- 23 criteria to be evaluated*2 of 3negative1 – Average E/e′ 142 – TR velocity 2.8 m/s3 – LA volume index 34 mL/m22 of 3 or3 of 3positivee’ 7 cm/sWhen only 2 criteria are available2 negativeNormal LAPGrade I diastolicdysfunctionIf symptomatic considerCAD or proceed todiastolic stress test1 positive and1 negative2 positiveCannot determine LAP anddiastolic dysfunctiongrade* LAPGrade II diastolicdysfunction LAPGrade III diastolicdysfunctionWhen LVEF is reduced or Diastolic Function isabnormal 2018 MFMER 3712003-2412
1/9/2018Prognosis of a patient after AMIE’ 8 cm/sTR 2 m/sec 2018 MFMER 3712003-25Anterior Wall Myocardial Infarction 2018 MFMER 3712003-2613
1/9/2018An elderly man with exertional dyspneaHFpEFE 80 A 80E’ 5 cm/secE/e’ 16TR 2.9 cm/s 2018 MFMER 3712003-27Diastolic function assessment in patients withmitral annulus calcificationE 100 cm/secLat e’ 4 cm/sMed e’ 3 cm/sTR 2.4 m/sec 2018 MFMER 3712003-2814
1/9/2018Mitral annulus e’ velocity vs MACMean age 73 yearsGroup 1n 79no MACGroup 2n 38mild MACGroup 3n 38mod-severe MAC01-119 119Septal e’5.96 1.825.15 1.565.05 1.930.01Lateral e’7.37 2.446.89 2.716.28 1.810.01Average e’6.63 26.02 1.795.67 1.690.01E/avg e’ ratio13 4.9315 8.9518 8.26 0.001VariableAgatston ScoreP for trendLV diastolic parameters are altered in the presence of MAC. This could be due todirect effects of MAC or might reflect truly reduced diastolic function. Interpretationof diastolic parameters in patients with MAC should be performedwith caution.Codolosa et al: Am J Cardiol 2016;117:847-852 2018 MFMER 3712003-29Proposed Clinical Algorithm for Estimationof Left Ventricular Filling Pressure inSubjects With Mitral Annular CalcificationInitial Cohort (n 50):Sensitivity: 81%Specificity: 100% 0.80.8-1.8Normal LVFPInitial: 8/9 (89%)Total 12/13 (92%)Total Cohort (n 71):Sensitivity: 85%Specificity: 95%Mitral E/A 1.8IVRT 80 msHigh LVFP 80 msNormal LVFPHigh LVFP4/9 (44%)9/14 (64%)16/16 (100%)23/24 (96%)10/10 (100%)11/11 (100%)Abudiab et al: Am Coll Cardiol Img, 2017 2018 MFMER 3712003-3015
1/9/2018Atrial Fib. And Mitral RegurgitationMedial e’ 8 cm/sE 90 cm/s E/e’ 11TR 2.5 m/sec 2018 MFMER 3712003-31Atrial Fib. And Mitral Regurgitation with exerciseE 90 cm/sE 130 cm/s and DT 120 msecMedial e’ 8 cm/sMedial e’ 9 cm/sTR 2.5 m/secTR 3.2 m/sec 2018 MFMER 3712003-3216
1/9/2018Diastolic Function in A. Fib DT 160 msec (with reduced EF) DT 130 msec poor survival (Hurley, Oh) Other measurements E acceleration 1900 cm/sec2 IVRT 65 msec E/e’ 11 IVRT/ T E-e’ TR velocity 2018 MFMER 3712003-33E 120E’ 6E/e’ 20JASE 1999 2018 MFMER 3712003-3417
1/9/2018An elderly patient with worsening dyspnea 2018 MFMER 3712003-35Take-home message Part 1 Abnormal LV relaxation is one of the first manifestation of diastolicdysfunction Mitral annulus e’ velocity is a clinically reliable parameter for LVrelaxation Diastolic function and filling pressure can be assessed by simpleEcho-Doppler parameters at rest and with exercise E/e’ 15 is specific for increased filling pressure 2018 MFMER 3712003-3618
1/9/2018Thanks for listening!oh.jae@mayo.edu 2018 MFMER 3712003-37Mitral Regurgitation and Diastolic FunctionE 80 cm/sE’ 6 cm/sE/e’ 13 2018 MFMER 3712003-3819
1/9/2018Mitral Regurgitation and Diastolic Function 2018 MFMER 3712003-39Assessment of Diastolic FillingBefore and after TAVRBaseline Normal Filling PressurePost TAVR with PVARIncrease in FP 2018 MFMER 3712003-4020
1/9/201889 year old with TAVR4 year follow-up 2018 MFMER 3712003-41Stages of Heart Failure2013/14 HF GuidelineAAt high risk forHF W/O SHD orsymptomsBStructural HeartDisease W/Osymptoms or signsCStructural HeartDisease W/symptoms or signsDRefractory HeartFailure 2018 MFMER 3712003-4221
1/9/2018Distribution of Values of LV Moprhofunctional Parametersfor Stage B Heart Failure CategorizationE/eʹ 13n 40Moderate-to-severe LVHn 123E/eʹ 13n 83E/eʹ 13n 71No or mild LVHn 387E/eʹ 13n 316Strain -18% (n 11)Strain -18% (n 29)Strain -18% (n 11)Strain -18% (n 60)Strain -18% (n 13)Strain -18% (n 58)Strain -49% (n 13)Strain -18% (n 267)Kosmala W et al: JACC 65:257-266, 2015 2018 MFMER 3712003-43Mitral A duration is shorter than PV ARIncreased LVEDP 2011 MFMER slide-44 2018 MFMER 3712003-4422
1/9/2018EDP(mm Hg)DopplerDeterminationof LVEDPMitral flow velocity454035302520151050-100LV pressure25 mm Hgr 0.68P 0.001-50050100PVad-Ad (ms)Rossvoll and Hatle:JACC, 19930.5Ma 100 msPVa 165 ms0.5Pulmonary veinLVEDP can be increased with normal mean LVdiastolic pressureCP1057136-18 2018 MFMER 3712003-45LEVDP Elevation with normal filling pressure 2018 MFMER 3712003-4623
1/9/2018“L” WaveDelayed Relaxation Increased Filling Pressure 2018 MFMER 3712003-47Mid-diastolic mitral flow (L)Delayed relaxation0.15m/s0.150.80m/sFrommelt et al: JASE 16:176, 2003CP1100934-2 2018 MFMER 3712003-4824
1/9/201895 year old woman 2018 MFMER 3712003-4995 year old woman 2018 MFMER 3712003-5025
1/9/2018 2018 MFMER 3712003-51Normal “L” wave 2018 MFMER 3712003-5226
This could be due to direct effects of MAC or might reflect truly reduced diastolic function. Interpretation . E acceleration 1900 cm/sec2 . Echo-Doppler parameters at rest and with exercise E/e' 15 is specific for increased filling pressure . 1/9/2018 19 2018 MFMER 3712003-37 .
cardiomyopathy (HCM) and restrictive cardiomyopathy (RCM) share a common feature of diastolic dysfunction [3, 4]. Diastolic dysfunction is an important clinical . ing that green tea extract EGCg is able to reverse diastolic dysfunction and improve cardiac relaxation in RCM mice.
CARDIOVASCULAR ICD-10 Angina, unstable I20.0 Angina, prinzmetal (coronary spasm) I20.1 Stable Angina I20.8 Angina, pectoris, NEC/NOS I20.9 Left heart failure, unspecified I50.1 Systolic heart failure, chronic I50.22 Systolic heart failure, acute on chronic I50.23 Diastolic heart failure, chronic I50.32 Diastolic heart failure, acute on chronic I50.33 Systolic and diastolic heart failure .
92. Mildly elevated blood pressure (Systolic 140-159 mm of Hg and/or Diastolic 90-99 mm of Hg) (%) 10.9 na 93. Moderately or severely elevated blood pressure (Systolic 160mm of Hg and/or Diastolic 100mm of Hg) (%) 4.8 na 94. Elevated blood pressure (Systolic 140 mm of Hg and/or Diastolic 90 mm of Hg) or taking medicine to
Diastolic heart failure occurs when signs and symptoms of heart failure are present but left ventricular systolic function is preserved (i.e., ejection fraction greater than 45 percent).
ANATOMY PHYSIOLOGY WORKBOOK 7a. Complete the table below to show the short-term and long-term effects of exercise in healthy adults for both systolic and diastolic blood pressure: Blood pressure Short-term effects Long-term effects Systolic pressure Diastolic pressure 7b. Explain why the short-term changes in systolic pressure that you have identified occur: 7c. Explain in more detail the long .
Ergonomics International Journal ISSN: 2577-2953 Diastolic Learning: Making the Tacit, Explicit Ergonomics Int J Diastolic Learning: Making the Tacit, Explicit Papaspyros S1,* and O’Regan D2 1Leeds Teaching Hospitals NHS Trust, UK 2Leeds General Infirmary, Cardiac Surgery Unit .
resonance (CMR) were performed sequentially on some of the monkeys. One monkey with moderate diastolic dysfunction, together with one ND monkey was sacri-ficed for histopathological and protein study. Some of the pathology was detailed by use of transmission electron microscope for observing microstructure and ultrastructure.
This manual describes the PHP extensions and interfaces that can be used with MySQL. For legal information, see the Legal Notices. For help with using MySQL, please visit the MySQL Forums, where you can discuss your issues with other MySQL users. Document generated on: 2021-03-01 (revision: 68830)
