ECHO 2013 / Echocardiography For Assessment of Diastolic Function
.pdf
Normal Mitral Annulus Velocities
•
•
•
Medial e’ ≥ 8 Lateral e’ ≥ 10
LA volume index ≥ 34 cc/m2
Athlete
Constriction
©2011 MFMER | slide-31
Analyze Ratio Between
Early Mitral Inflow Velocity & Early Mitral Annulus Velocity
E
E’
©2011 MFMER | slide-32
Normal or Pseudonormal?
E=1.25 m/sec
DT=290 msec
Annulus DTI
E/e =21
e =0.06 m/sec
•62-year-old man
•9 months s/p cardioversion from aflutter
•LA volume index 62 cc/m2
CP993639-22
Left Ventricular Mean Diastolic Pressure vs Mitral Septal E/E´ Ratio
For M-LVDP >15 mm Hg
•Septal E/e´ >15 had 86% specificity
•Septal E/e´ <8 had 97% negative predictive value
Ommen SR: Circulation 102, 10/10/00
CP1043937-12
Mean LV Diastolic Pressure vs Mitral E/E´
M LVDP
(mm Hg)
40 
EF >50%
35 
EF <50%
30
25
20
15
10
5
0
<8 |
8-15 |
>15 |
E/E´
Ommen SR: Circulation 102, 10/10/00
CP1043937-11
Mitral E/Ea Ratio for PCWP
Using Lateral Annulus
Sensitivity and Specificity of Various E/Ea Cutoffs for PCWP >15 mm Hg in the 180 Patients Combined: NSR17 (n=60) and ST (n=120)
|
Sensitivity |
Specificity |
E/Ea |
(%) |
(%) |
>8 |
99 |
58 |
>10 |
92 |
80 |
>12 |
74 |
92 |
>15 |
46 |
100 |
Nagueh SF: Circulation 98:1644, 10/20/98
3000470-10
LV Diastolic
Flow Propagation Velocity (Vp)
•Vp ≥ 50 cm/sec is normal
•E / Vp ratio ≥ 2.5 correlates with PCWP > 15
•Vp most reliable as index of LV relaxation for patients with dilated LV and decreased LVEF
Flow Propagation Velocity
E/FPV = 4.4
FPV = 32 cm/sec
E = 1.4 m/sec
Nagueh SF; JASE 22(2); February 2009