ECHO 2013 / Echocardiography For Assessment of Diastolic Function
.pdf
ADEPT Study
•225 consecutive patients
•Age 18 to 75 years
•LVEF < 35%
•NYHA class II-IV
•Patients with significant valve disease
were excluded
Troughton RW: AJC 96(2), 7/15/05
ADEPT Study
•Patients followed for median of 10 months
•E/Ea septal and E/FPV were predictors of outcome
•Ea and FPV were not predictors
•DT, E/A ratio, and Systolic/Diastolic PV ratio were predictive
Troughton RW: AJC 96(2), 7/15/05
Event*-Free survival vs E/Ea and E/Vp
Event-free survival (%)
100 |
100 |
E/Ea <16 |
80 |
80 |
E/Vp <2.7 |
60 |
* |
60 |
** |
|
|
|
|
40 |
|
|
E/Vp >2.7 |
|
40 |
|
|
|
E/Ea >16 |
|
|
20 |
|
20 |
|
E/Ea |
|
|
E/VP |
|
0 |
|
|
|
|
|
0 |
|
|
|
|
|
|
0 |
200 |
400 |
600 |
800 |
0 |
200 |
400 |
600 |
800 |
||
|
|
|
|
|
|
Events |
|
|
|
|
|
Events |
Below |
105 |
76 |
47 |
30 |
18 |
(23) |
104 |
69 |
41 |
31 |
13 |
(23) |
Above |
105 |
65 |
33 |
16 |
2 |
(38) |
103 |
69 |
38 |
16 |
6 |
(38) |
*Death, transplant, or hospitalization for heart failure
Troughton RW: AJC 96(2), 7/15/05
CP1255416-13
Event*-Free survival vs
MV DT and Pulmonary Vein S/D
Event-free survival (%)
100
80
60
40
20
DT >170 ms |
100 |
S/D >1 |
|
|
80 |
|
|
40 |
|
DT <170 ms |
|
|
DT |
20 |
S/D |
** |
60 |
** |
|
|
S/D <1 |
|
0 |
|
|
|
|
|
0 |
|
|
|
|
|
|
0 |
200 |
400 |
600 |
800 |
0 |
200 |
400 |
600 |
800 |
||
|
|
|
|
|
|
Events |
|
|
|
|
|
Events |
Below |
98 |
57 |
26 |
10 |
1 |
(43) |
109 |
68 |
33 |
14 |
1 |
(49) |
Above |
97 |
73 |
47 |
35 |
19 |
(14) |
110 |
80 |
51 |
36 |
20 |
(11) |
*Death, transplant, or hospitalization for heart failure
Troughton RW: AJC 96(2), 7/15/05
CP1255416-14
ADEPT Study
Feasibility of Measurements
•Transmitral flow velocities and color M mode 92%
•TDI of mitral annulus 98%
•Pulmonary vein velocities 85%
Troughton RW: AJC 96(2), 7/15/05
For Patients with Normal LVEF
Use the Following Cutoffs to Predict Increased LV Filling Pressure
•
•
•
Septal E/e’ ≥ 15
Lateral E/e’ ≥ 12
Average E/e’ ≥ 13
Journal of the American Society of Echocardiography
Volume 22(2); February 2009
To Assess Left Ventricular Filling Pressure Use TDI of the
Lateral Mitral Annulus for Patients with
•Primary pulmonary hypertension
•Thromboembolic pulmonary hypertension
•Pulmonary hypertension due to lung disease
•Pulmonary hypertension due to autoimmune disease
For Patients with Suspected Cardiac Constriction
•Measure e’ from both medial and lateral annulus
•With constriction, both will be larger than expected for age and clinical condition
•With constriction, medial e’ will often be larger than lateral e’
Nagueh SF; JASE 22(2); February 2009
Pseudonormal
Mitral Doppler Pattern
Valsalva maneuver to Uncover Delayed Relaxation