Evaluation of Left Ventricular Diastolic Dysfunction by Doppler and 2D Speckle-tracking Imaging in Patients with Primary Pulmonary Hypertension

Size: px
Start display at page:

Download "Evaluation of Left Ventricular Diastolic Dysfunction by Doppler and 2D Speckle-tracking Imaging in Patients with Primary Pulmonary Hypertension"

Transcription

1 ESC Congress 2011.No Evaluation of Left Ventricular Diastolic Dysfunction by Doppler and 2D Speckle-tracking Imaging in Patients with Primary Pulmonary Hypertension Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan Konomi Sakata, Kazuki Sato, Toshinori Minamishima, Kazuya Takemoto, Junsuke Sueoka, Touru Sato, Hideaki Yoshino Presenter - from 08:30 to 12:30. 28/08/2011 Room: Posters - Poster Zone C Sess. Title : Poster session 1. Pres. N : / from 08:30 to 12:30

2 Abstract Background: In patients with Primary Pulmonary hypertension (PPH), RV pressure overload causes right ventricular dilation and left ventricular (LV) cavity reduction. OBJECTS: We sought to investigate the LV diastolic dysfunction using Doppler and 2D speckle- tracking imaging (2DSTI) in patients with PPH. Methods: We performed Doppler and speckle-tracking imaging in 38 patents with PPH ( PH) and 18 control subjects ( N:30.6±4.6 years). Fifteen ( PH-HF) of 38 patients in PH were complicated with right heart failure, and other 23 patients ( PH-N) were not complicated. We measured early and late diastolic peak velocities of mitral inflow (E and A), and deceleration time (DT), and the mitral annular velocities (e ) in two sites by tissue Doppler imaging, and the ratio of early mitral inflow to mitral annular velocity (E/e'). Global LV peak relaxation strain rate (RSR) during early diastole were analyzed by 2DSTI in the longitudinal direction. Results: E (60.5±3.5 vs. 84.3±3.5 cm/s : p < ) and E/A (0.8±0.07 vs. 1.8±0.7: p < ) were significantly lower in PH than in N. DT (181.2±43.7 vs ±31.5 ms: p= ) was longer in PH. e (14.3±0.6 vs. 8.8±0.5 cm/s : p< ) was lower and E/e (7.8±0.4 vs. 5.9±0.4: p = ) was higher in PH than in N. RSR was significantly lower in PH (0.9±0.1 vs. 1.4±0.1: p = ). Conclusion: LV diastolic dysfunction appeared in patients with PPH. RV pressure overload and reduction of RV output caused impaired LV filling.

3 Cardiac Dysfunction in Patients with Pulmonary Artery Hypertension pulmonary vascular resistance increase Pulmonary artery pressure increase RV afterload increase RV dilatation RV free wall tension increase RV hypertrophy abnormal curvature of interventricular septum LV compliance decrease Preload reserve limit afterload mismatch Tricuspid regurgitation LV output reduced RV ischemia RV output reduce RV: right ventricular, LV: left ventricular

4 Background Pulmonary arterial hypertension (PAH) Primary pulmonary arterial hypertension (PAH) is characterized by obstructive lesions of the small pulmonary vessels leading to increased pulmonary vascular resistance (PVR) and pulmonary artery pressure (PAP). The elevations of PVR and PAP causes right ventricular (RV) pressure overload, which leads to functional and morphologic alterations of both RV and left ventricle (LV), such as increased RV end-diastolic volume (RVEDV) and LV chamber distortion (decreased LV end-diastolic volume (LVEDV) and flattening or leftward displacement of the interventricular septum). These changes result in a decreased cardiac output, and eventually leads to cardiac failure and death.

5 Background Left Ventricular Dysfunction in Patients with Pulmonary Arterial Hypertension (PAH) The decrease in LVEDV is a consequence of impaired LV filling in IPAH. Impaired LV filling in RV pressure overload state might be the result of a decrease of stroke volume or compression of the LV due to an increased RVEDV. The decrease in LVEDV is strong predictors of mortality in IPAH. (European Heart Journal 2007;28, ) In PAH patients with decreased LVEDV, the quantitative assessment of global and regional LV myocardial function is important to evaluate impaired LV filling and LV diastolic dysfunction.

6 Pulmonary artery hypertension (PAH) causes right ventricular (RV) pressure overload, which leads to functional and morphologic alterations of both right and left ventricles (LV). These changes result in a decreased cardiac output, and leads to cardiac failure. Right ventricular (RV) pressure overload inceases RV end diastolic volume (RVEDV) causesthe abnormal LV diastolic function seen in a state was a consequence of a decrease of stroke volume, and compression of the LV due to an increased RVEDV in patients with PAH.

7 Background Tissue Doppler Imaging (TDI) The mitral annular systolic (s ) and early (e ) and late (a ) diastolic myocardial velocities were acquired in apical fourchamber views at the junction of the left ventricular free wall and the leaflet of the mitral valve using tissue doppler imaging (TDI). The mitral annular doppler velocities can evaluate LV diastolic function noninvasively and quantitatively. Eur Heart J 2001;22: Echocardiography 2008;25: J Am Soc Echocardiogr 2004;17: Echocardiography 2006;23:750 5.

8 Background Strain and Strain Rate by Two-Dimensional Speckle Tracking Imaging Two-dimensional speckle tracking imaging (2DSTI) is a reliable and feasible technique of tracking myocardial deformation angle-independently and allowing a comprehensive and quantitative assessment of global and regional myocardial function. (Cardiovasc Ultrasound ;5:27. ) Strain and strain rate by two-dimensional speckle tracking imaging (2DSTI) may be useful for quantitative evaluation of LV and RV function in patients with PAH.

9 Objects evaluate the LV diastolic dysfunction caused by functional and morphologic alterations of both RV and LV in patients with PAH, using Doppler and 2DSTI quantitatively. investigate whether or not the LV diastolic dysfunction using Doppler and 2DSTI is associated with the severity of cardiac function in patients with PAH.

10 Methods Study Patients Pulmonary arterial hypertension ( PAH): 50 patients mean age ; 44±10 years Healthy control subjects ( N) : 18 subjects mean age ; 40±9 years PAH has been defined as an increase in mean pulmonary arterial pressure 25mmHg at rest as assessed by right heart catheterization. All patients were in sinus rhythm, and had no left heart disease.

11 Methods Two Dimensional Transthoracic Echocardiography (2DE) Right ventricular end-diastolic area index (RVEDAI) Right ventricular end-systolic area index (RVESAI) RV fractional area change (%RVFAC) =100 (RVEDA ー RVESA)/RVEDA Left ventricular end-diastolic area index (LVEDAI) Left ventricular end-systolic area index (LVESAI) Left ventricular ejection fraction (LVEF) using Modified Simpson method TR jet pressure gradient by Doppler echocardiography the size of the inferior vena cava (IVC) and the changes in its size during respiration

12 Methods Echocardiography Artida (Toshiba Medical Systems) Transthoracic echocardiogram was performed using PST-30SBT probe. Two-dimensional transthoracic Echocardiography (2DE) Pulsed Doppler Imaging: mitral inflow Tissue Doppler Imaging: myocardial velocities of the mitral annulus 2D Speckle tracking imaging (2DSTI): longitudinal strain and strain rate 2D-Speckle-tracking analysis: 2D Wall Motion Tracking (Toshiba Medical Systems)

13 Methods Pulsed Doppler &Tissue Doppler Imaging The mitral annular motion velocity in lateral segment peak early diastolic myocardial velocity (e ) The mitral inflow velocity peak early diastolic mitral inflow velocity (E) peak late diastolic mitral inflow velocity (A) The isovolumic relaxation time (IRT) The deceleration time(dt) of early mitral inflow (E) E A s DT e a Pulsed Doppler mitral inflow image mitral annular motion velocity

14 Methods 2D Speckle Tracking Imaging Longitudinal Strain Rate Global LV Strain Rate LV free wall Strain Rate Global left ventricle (LV) longitudinal strain rate (SR) in the apical 4-chamber view were calculated with the use of the entire length of the LV myocardium. LV free wall is divided into three segments. LV free wall longitudinal SR in mid-ventricular segments of the LV free walls in the 4-chamber apical view was evaluated.

15 Methods LV Longitudinal Diastolic Strain Rate During IVR period and Early Diastolic Phase RSR AVC MVO LV EDSR RSR (relaxation strain rate ) :Peak relaxation SR during the IVR period LV EDSR (early diastolic SR) : Peak LV early diastolic SR during early diastolic phase AVC: aortic valve closure MVO: mitral valve opening LV free wall EDSR Global LV EDSR LV longitudinal strain rate curve Wang J. Circulation. 2007;115:

16 Methods Right Heart Catheterization All patients underwent right heart catheterization within the same day performed 2D echocardiography. Pulmonary artery pressure (PAP) Right atrial pressure (RAP) Pulmonary vascular resistance (PVR) Cardiac index (CI)

17 Results Patients Characteristics Characteristic PAH N P value Number Age (years) 44±10 40± Female(%) 40 (80%) 13 (72%) 0.07 Heart rate (b.p.m.) 81±17 66±10 <0.01 2DE data TR pressure gradient 79±26 22±10 <0.01 RVEDAI (cm/m 2 ) 20±5 11±2 <0.01 RVESAI (cm/m 2 ) 13±5 6±1 <0.01 %RVFAC (%) 31±1 45±4 <0.01 LVEDVI (ml/m 2 ) 29±11 49±6 <0.01 LVESVI (ml/m 2 ) 9±5 15±8 <0.01 LVEF (%) 70±7 67±6 0.12

18 Characteristic PAH N P value Doppler data E (cm/s) 55±19 83±19 <0.01 A (cm/s) 70±14 49±12 <0.01 E/A 0.8± ±0.3 <0.01 DT (ms) 180±40 138±25 <0.01 IRT (ms) 75±23 52±23 <0.01 e 8±3 14±3 <0.01 E/e 6.4± ± D speckle tracking LV free wall EDSR 1.10± ±0.64 <0.01 Global LV EDSR 0.98± ±0.48 <0.01 RSR 0.17± ±0.30 <0.01

19 Results Classification of PAH Patients using Appearance of Heart Failure PAH 50 patients PAH-HF 12 patients PAH-N 38 patients Patients with right heart failure (NYHA III or IV)

20 Results Patient Characteristics in Two PAH s Characteristic PAH-HF PAH-N P value number Age (years) 43±12 44± Female (%) 9 (75%) 30 (79%) 0.89 Heart rate (b.p.m.) 85±19 76± DE data RVEDAI (cm/m 2 ) 21±5 15±4 <0.01 RVESAI (cm/m 2 ) 17±6 11±4 <0.01 %RVFAC (%) 24±9 36±11 <0.01 LVEDVI (ml/m 2 ) 20±7 35±11 <0.01 LVESVI (ml/m 2 ) 5±2 11±5 <0.01 LVEF (%) 72±7 70± BNP 460±53 35±40 <0.01

21 Results Patient Characteristics in Two PAH s Characteristic PAH-HF PAH-N P value Systolic PAP by Doppler (mmhg) RV Catheter Data 90±27 74± Mean PAP (mmhg) 48±10 39±11 <0.01 Systolic PAP (mmhg) 83±16 65±19 <0.01 RVR 14.5± ±4.8 <0.01 RAP (mmhg) 11±8 6±3 <0.01 PCWP (mmhg) 8±3 9± CI (L/min/m2) 2.0± ±1.2 <0.01

22 Results Mitral Inflow Pulsed Doppler in PAH Patients (cm/s) 100 E P<0.001 E/A P<0.001 (ms) 300 DT P<0.001 (ms) 120 IRT P< ,2 60 0, , PAH-HF PAH-N 0 PAH-HF PAH-N 0 PAH-HF PAH-N 0 PAH-HF PAH-N

23 Results Mitral Anulus Tissue Doppler in PAH Patients 20 e' P< PAH-HF PAH-N

24 LV EDSR Global LV EDSR RSR Results LV Longitudinal Diastolic Strain Rate During IVR period & Early Diastolic Phase 2 LV free wall EDSR (s -1 ) P=0.007 (s -1 ) 2 Global LV EDSR P< ,4 (s -1 ) RSR P= , ,2 0,1 0 PAH-HF PAH-N 0 PAH-HF PAH-N 0 PAH-HF PAH-N

25 RSR RSR Results Correlation between RSR and BNP, Cardiac Index 0,5 0,4 (s -1 ) (s -1 ) R==0.450 R2=0.202 P= ,5 0,4 R==0.376 R2=0.141 P= ,3 0,3 0,2 0,2 0,1 0, CI BNP(LN)

26 Global LV EDSR Global LV EDSR Results Correlation between Global LV early diastolic SR and BNP, Cardiac Index 2,5 (s -1 ) (s -1 ) 2 R=0.389 R2=0.154 P= ,5 2 R= R2=0.201 P= ,5 1, ,5 0, CI BNP(LN)

27 LV EDSR LV EDSR Results 2,5 Correlation Between LV free wall EDSR and BNP, Cardiac Index (s -1 ) (s -1 ) 2 R=0.389 R2=0.154 P= ,5 2 R=0.354 R2=0.125 P= ,5 1, ,5 0, CI BNP(LN)

28 Conclusion The LV diastolic dysfunction ( abnormal LV relaxation and impaired LV filling) appeared in patients with PAH. Using 2DSTI, LV diastolic dysfunction was seen in the LV free wall and global LV wall, and the severity of heart failure in PAH increased according to LV diastolic dysfunction. The E, E/A, e, and LV longitudinal strain rate by 2DSTI are useful parameters for the noninvasive and quantitative assessment of LV diastolic dysfunction and the severity of cardiac dysfunction in patients with PAH.

Evaluation of right atrial function using right atrial speckle tracking analysis in patients with pulmonary artery hypertension

Evaluation of right atrial function using right atrial speckle tracking analysis in patients with pulmonary artery hypertension J Echocardiogr (2016) 14:30 38 DOI 10.1007/s12574-015-0270-4 ORIGINAL INVESTIGATION Evaluation of right atrial function using right atrial speckle tracking analysis in patients with pulmonary artery hypertension

More information

Quantitation of right ventricular dimensions and function

Quantitation of right ventricular dimensions and function SCCS Basics of cardiac assessment Quantitation of right ventricular dimensions and function Tomasz Kukulski, MD PhD Dept of Cardiology, Congenital Heart Disease and Electrotherapy Silesian Medical University

More information

The importance of left atrium in LV diastolic function

The importance of left atrium in LV diastolic function II Baltic Heart Failure Meeting and Congress of Latvian Society of Cardiology The importance of left atrium in LV diastolic function Dr. Artem Kalinin Eastern Clinical University Hospital Riga 30.09.2010.

More information

LV FUNCTION ASSESSMENT: WHAT IS BEYOND EJECTION FRACTION

LV FUNCTION ASSESSMENT: WHAT IS BEYOND EJECTION FRACTION LV FUNCTION ASSESSMENT: WHAT IS BEYOND EJECTION FRACTION Jamilah S AlRahimi Assistant Professor, KSU-HS Consultant Noninvasive Cardiology KFCC, MNGHA-WR Introduction LV function assessment in Heart Failure:

More information

Evalua&on)of)Le-)Ventricular)Diastolic) Dysfunc&on)by)Echocardiography:) Role)of)Ejec&on)Frac&on)

Evalua&on)of)Le-)Ventricular)Diastolic) Dysfunc&on)by)Echocardiography:) Role)of)Ejec&on)Frac&on) Evalua&on)of)Le-)Ventricular)Diastolic) Dysfunc&on)by)Echocardiography:) Role)of)Ejec&on)Frac&on) N.Koutsogiannis) Department)of)Cardiology) University)Hospital)of)Patras)! I have no conflicts of interest

More information

Little is known about the degree and time course of

Little is known about the degree and time course of Differential Changes in Regional Right Ventricular Function Before and After a Bilateral Lung Transplantation: An Ultrasonic Strain and Strain Rate Study Virginija Dambrauskaite, MD, Lieven Herbots, MD,

More information

THE RIGHT VENTRICLE IN PULMONARY HYPERTENSION R. DRAGU

THE RIGHT VENTRICLE IN PULMONARY HYPERTENSION R. DRAGU THE RIGHT VENTRICLE IN PULMONARY HYPERTENSION R. DRAGU Cardiology Dept. Rambam Health Care Campus Rappaport Faculty of Medicine Technion, Israel Why the Right Ventricle? Pulmonary hypertension (PH) Right

More information

Atrial dyssynchrony syndrome: An overlooked cause of heart failure with normal ejection fraction

Atrial dyssynchrony syndrome: An overlooked cause of heart failure with normal ejection fraction Atrial dyssynchrony syndrome: An overlooked cause of heart failure with normal ejection fraction JC Eicher, G Laurent, O Barthez, A Mathé, G Bertaux, JE Wolf Heart Failure Treatment Unit, Rhythmology and

More information

Appendix II: ECHOCARDIOGRAPHY ANALYSIS

Appendix II: ECHOCARDIOGRAPHY ANALYSIS Appendix II: ECHOCARDIOGRAPHY ANALYSIS Two-Dimensional (2D) imaging was performed using the Vivid 7 Advantage cardiovascular ultrasound system (GE Medical Systems, Milwaukee) with a frame rate of 400 frames

More information

Highlights from EuroEcho 2009 Echo in cardiomyopathies

Highlights from EuroEcho 2009 Echo in cardiomyopathies Highlights from EuroEcho 2009 Echo in cardiomyopathies Bogdan A. Popescu University of Medicine and Pharmacy, Bucharest, Romania ESC Congress 2010 Hypertrophic cardiomyopathy To determine the differences

More information

Tissue Doppler Imaging in Congenital Heart Disease

Tissue Doppler Imaging in Congenital Heart Disease Tissue Doppler Imaging in Congenital Heart Disease L. Youngmin Eun, M.D. Department of Pediatrics, Division of Pediatric Cardiology, Kwandong University College of Medicine The potential advantage of ultrasound

More information

Evaluation of the Right Ventricle in Candidates for Right Ventricular Assist Device Implantation.

Evaluation of the Right Ventricle in Candidates for Right Ventricular Assist Device Implantation. Evaluation of the Right Ventricle in Candidates for Right Ventricular Assist Device Implantation. Evaluation of RVAD Function. Ioannis A Paraskevaidis Attikon University Hospital Historical Perspective

More information

Hemodynamic Assessment. Assessment of Systolic Function Doppler Hemodynamics

Hemodynamic Assessment. Assessment of Systolic Function Doppler Hemodynamics Hemodynamic Assessment Matt M. Umland, RDCS, FASE Aurora Medical Group Milwaukee, WI Assessment of Systolic Function Doppler Hemodynamics Stroke Volume Cardiac Output Cardiac Index Tei Index/Index of myocardial

More information

An Integrated Approach to Study LV Diastolic Function

An Integrated Approach to Study LV Diastolic Function An Integrated Approach to Study LV Diastolic Function Assoc. Prof. Adriana Ilieşiu, FESC University of Medicine Carol Davila Bucharest, Romania LV Diastolic Dysfunction impaired relaxation (early diastole)

More information

Left ventricular diastolic function and filling pressure in patients with dilated cardiomyopathy

Left ventricular diastolic function and filling pressure in patients with dilated cardiomyopathy Left ventricular diastolic function and filling pressure in patients with dilated cardiomyopathy Bogdan A. Popescu University of Medicine and Pharmacy Bucharest, Romania My conflicts of interest: I have

More information

RIGHT VENTRICULAR SIZE AND FUNCTION

RIGHT VENTRICULAR SIZE AND FUNCTION RIGHT VENTRICULAR SIZE AND FUNCTION Edwin S. Tucay, MD, FPCC, FPCC, FPSE Philippine Society of Echocardiography Quezon City, Philippines Echo Mission, BRTTH, Legaspi City, July 1-2, 2016 NO DISCLOSURE

More information

Value of echocardiography in chronic dyspnea

Value of echocardiography in chronic dyspnea Value of echocardiography in chronic dyspnea Jahrestagung Schweizerische Gesellschaft für /Schweizerische Gesellschaft für Pneumologie B. Kaufmann 16.06.2016 Chronic dyspnea Shortness of breath lasting

More information

Diastolic Function: What the Sonographer Needs to Know. Echocardiographic Assessment of Diastolic Function: Basic Concepts 2/8/2012

Diastolic Function: What the Sonographer Needs to Know. Echocardiographic Assessment of Diastolic Function: Basic Concepts 2/8/2012 Diastolic Function: What the Sonographer Needs to Know Pat Bailey, RDCS, FASE Technical Director Beaumont Health System Echocardiographic Assessment of Diastolic Function: Basic Concepts Practical Hints

More information

LV geometric and functional changes in VHD: How to assess? Mi-Seung Shin M.D., Ph.D. Gachon University Gil Hospital

LV geometric and functional changes in VHD: How to assess? Mi-Seung Shin M.D., Ph.D. Gachon University Gil Hospital LV geometric and functional changes in VHD: How to assess? Mi-Seung Shin M.D., Ph.D. Gachon University Gil Hospital LV inflow across MV LV LV outflow across AV LV LV geometric changes Pressure overload

More information

Transthoracic echocardiography in the evaluation of pediatric pulmonary hypertension and ventricular dysfunction

Transthoracic echocardiography in the evaluation of pediatric pulmonary hypertension and ventricular dysfunction REVIEW ARTICLE Transthoracic echocardiography in the evaluation of pediatric pulmonary hypertension and ventricular dysfunction Martin Koestenberger, 1 Mark K. Friedberg, 2 Eirik Nestaas, 3 Ina Michel-Behnke,

More information

Right Heart Catheterization. Franz R. Eberli MD Chief of Cardiology Stadtspital Triemli, Zurich

Right Heart Catheterization. Franz R. Eberli MD Chief of Cardiology Stadtspital Triemli, Zurich Right Heart Catheterization Franz R. Eberli MD Chief of Cardiology Stadtspital Triemli, Zurich Right Heart Catheterization Pressure measurements Oxygen saturation measurements Cardiac output, Vascular

More information

Questions on Chamber Quantitation

Questions on Chamber Quantitation Questions on Chamber Quantitation @RobertoMLang Which of the following statements is true? 1. The aortic annulus should be measured in midsystole. 2. The aortic annulus should be measured in enddiastole.

More information

How to assess ischaemic MR?

How to assess ischaemic MR? ESC 2012 How to assess ischaemic MR? Luc A. Pierard, MD, PhD, FESC, FACC Professor of Medicine Head, Department of Cardiology University Hospital Sart Tilman, Liège ESC 2012 No conflict of interest Luc

More information

Mechanisms of False Positive Exercise Electrocardiography: Is False Positive Test Truly False?

Mechanisms of False Positive Exercise Electrocardiography: Is False Positive Test Truly False? Mechanisms of False Positive Exercise Electrocardiography: Is False Positive Test Truly False? Masaki Izumo a, Kengo Suzuki b, Hidekazu Kikuchi b, Seisyo Kou b, Keisuke Kida b, Yu Eguchi b, Nobuyuki Azuma

More information

좌심실수축기능평가 Cardiac Function

좌심실수축기능평가 Cardiac Function Basic Echo Review Course 좌심실수축기능평가 Cardiac Function Seonghoon Choi Cardiology Hallym university LV systolic function Systolic function 좌심실수축기능 - 심근의수축으로심실에서혈액을대동맥으로박출하는기능 실제임상에서 LV function 의의미 1Diagnosis

More information

Review Article Transthoracic Echocardiography in Children and Young Adults with Congenital Heart Disease

Review Article Transthoracic Echocardiography in Children and Young Adults with Congenital Heart Disease International Scholarly Research Network ISRN Pediatrics Volume 2012, Article ID 753481, 15 pages doi:10.5402/2012/753481 Review Article Transthoracic Echocardiography in Children and Young Adults with

More information

DECLARATION OF CONFLICT OF INTEREST. None

DECLARATION OF CONFLICT OF INTEREST. None DECLARATION OF CONFLICT OF INTEREST None Hot Topics in Echocardiography: The position of the EAE EAE / ASE recommendation about Echo Assessment of Cardiac Mechanics Jens-Uwe Voigt Dpt. of Cardiovascular

More information

2/2/2011. Strain and Strain Rate Imaging How, Why and When? Movement vs Deformation. Doppler Myocardial Velocities. Movement. Deformation.

2/2/2011. Strain and Strain Rate Imaging How, Why and When? Movement vs Deformation. Doppler Myocardial Velocities. Movement. Deformation. Strain and Strain Rate Imaging How, Why and When? João L. Cavalcante, MD Advanced Cardiac Imaging Fellow Cleveland Clinic Foundation Disclosures: No conflicts of interest Movement vs Deformation Movement

More information

DOPPLER HEMODYNAMICS (1) QUANTIFICATION OF PRESSURE GRADIENTS and INTRACARDIAC PRESSURES

DOPPLER HEMODYNAMICS (1) QUANTIFICATION OF PRESSURE GRADIENTS and INTRACARDIAC PRESSURES THORAXCENTRE DOPPLER HEMODYNAMICS (1) QUANTIFICATION OF PRESSURE GRADIENTS and INTRACARDIAC PRESSURES J. Roelandt DOPPLER HEMODYNAMICS Intracardiac pressures and pressure gradients Volumetric measurement

More information

Basic Approach to the Echocardiographic Evaluation of Ventricular Diastolic Function

Basic Approach to the Echocardiographic Evaluation of Ventricular Diastolic Function Basic Approach to the Echocardiographic Evaluation of Ventricular Diastolic Function J A F E R A L I, M D U N I V E R S I T Y H O S P I T A L S C A S E M E D I C A L C E N T E R S T A F F C A R D I O T

More information

Københavns Universitet

Københavns Universitet university of copenhagen Københavns Universitet Total average diastolic longitudinal displacement by colour tissue doppler imaging as an assessment of diastolic function de Knegt, Martina Chantal; Biering-Sørensen,

More information

Fetal cardiac function: what to use and does it make a difference?

Fetal cardiac function: what to use and does it make a difference? 17 th International Conference on Prenatal Diagnosis and Therapy Lisbon, June 2013 Fetal cardiac function: what to use and does it make a difference? Fàtima Crispi Department of Maternal-Fetal Medicine,

More information

ASCeXAM / ReASCE. Practice Board Exam Questions Monday Morning

ASCeXAM / ReASCE. Practice Board Exam Questions Monday Morning ASCeXAM / ReASCE Practice Board Exam Questions Monday Morning Ultrasound Physics Artifacts Doppler Physics Imaging, Knobology, and Artifacts Echocardiographic Evaluation of the RV Tricuspid and Pulmonary

More information

The right heart: the Cinderella of heart failure

The right heart: the Cinderella of heart failure The right heart: the Cinderella of heart failure Piotr Ponikowski, MD, PhD, FESC Medical University, Centre for Heart Disease Clinical Military Hospital Wroclaw, Poland none Disclosure Look into the Heart

More information

Mechanisms of heart failure with normal EF Arterial stiffness and ventricular-arterial coupling. What is the pathophysiology at presentation?

Mechanisms of heart failure with normal EF Arterial stiffness and ventricular-arterial coupling. What is the pathophysiology at presentation? Mechanisms of heart failure with normal EF Arterial stiffness and ventricular-arterial coupling What is the pathophysiology at presentation? Ventricular-arterial coupling elastance Central arterial pressure

More information

Echocardiography as a diagnostic and management tool in medical emergencies

Echocardiography as a diagnostic and management tool in medical emergencies Echocardiography as a diagnostic and management tool in medical emergencies Frank van der Heusen MD Department of Anesthesia and perioperative Care UCSF Medical Center Objective of this presentation Indications

More information

Pulmonary Hypertension: Echocardiographic Evaluation of Pulmonary Hypertension and Right Ventricular Function. Irmina Gradus-Pizlo, MD

Pulmonary Hypertension: Echocardiographic Evaluation of Pulmonary Hypertension and Right Ventricular Function. Irmina Gradus-Pizlo, MD Pulmonary Hypertension: Echocardiographic Evaluation of Pulmonary Hypertension and Right Ventricular Function Irmina Gradus-Pizlo, MD Disclosures: Nothing to disclose Overview Is pulmonary hypertension

More information

Assessing the Impact on the Right Ventricle

Assessing the Impact on the Right Ventricle Advances in Tricuspid Regurgitation Congress of the European Society of Cardiology (ESC) Munich, August 25-29, 2012 Assessing the Impact on the Right Ventricle Stephan Rosenkranz, MD Clinic III for Internal

More information

Incorporating the New Echo Guidelines Into Everyday Practice

Incorporating the New Echo Guidelines Into Everyday Practice Incorporating the New Echo Guidelines Into Everyday Practice Clinical Case RIGHT VENTRICULAR FAILURE Gustavo Restrepo MD President Elect Interamerican Society of Cardiology Director Fellowship Training

More information

Altered left ventricular geometry and torsional mechanics in high altitude-induced pulmonary hypertension:

Altered left ventricular geometry and torsional mechanics in high altitude-induced pulmonary hypertension: Altered left ventricular geometry and torsional mechanics in high altitude-induced pulmonary hypertension: a 3-D echocardiographic study B.W. De Boeck,* S. Kiencke, C. Dehnert, K. Auinger, # M. Maggiorini,

More information

Jong-Won Ha*, Jeong-Ah Ahn, Jae-Yun Moon, Hye-Sun Suh, Seok-Min Kang, Se-Joong Rim, Yangsoo Jang, Namsik Chung, Won-Heum Shim, Seung-Yun Cho

Jong-Won Ha*, Jeong-Ah Ahn, Jae-Yun Moon, Hye-Sun Suh, Seok-Min Kang, Se-Joong Rim, Yangsoo Jang, Namsik Chung, Won-Heum Shim, Seung-Yun Cho Eur J Echocardiography (2006) 7, 16e21 CLINICAL/ORIGINAL PAPERS Triphasic mitral inflow velocity with mid-diastolic flow: The presence of mid-diastolic mitral annular velocity indicates advanced diastolic

More information

Evaluation of the Right Ventricle and Risk Stratification for Sudden Cardiac Death

Evaluation of the Right Ventricle and Risk Stratification for Sudden Cardiac Death Evaluation of the Right Ventricle and Risk Stratification for Sudden Cardiac Death Presenters: Sabrina Phillips, MD FACC FASE Director, Adult Congenital Heart Disease Services The University of Oklahoma

More information

Swan Song: Echocardiography as a Pulmonary Artery Catheter? Interdepartmental Division of Critical Care Medicine

Swan Song: Echocardiography as a Pulmonary Artery Catheter? Interdepartmental Division of Critical Care Medicine Swan Song: Echocardiography as a Pulmonary Artery Catheter? The swan is without spot, and it sings sweetly as it dies, that song ending its life Leonardo Da Vinci Curr Opin Anesthesiol 2016, 29:36 45 Circulation.

More information

Μαρία Μπόνου Διευθύντρια ΕΣΥ, ΓΝΑ Λαϊκό

Μαρία Μπόνου Διευθύντρια ΕΣΥ, ΓΝΑ Λαϊκό Μαρία Μπόνου Διευθύντρια ΕΣΥ, ΓΝΑ Λαϊκό Diastolic HF DD: Diastolic Dysfunction DHF: Diastolic HF HFpEF: HF with preserved EF DD Pathophysiologic condition: impaired relaxation, LV compliance, LV filling

More information

Pulmonary Hypertension. Echocardiography: Pearls & Pitfalls

Pulmonary Hypertension. Echocardiography: Pearls & Pitfalls Pulmonary Hypertension Echocardiography: Pearls & Pitfalls Αθανάσιος Γ. Κουτσάκης Ειδικευόμενος Καρδιολογίας Α Καρδιολογική Κλινική ΑΠΘ Σεμινάρια Ομάδων Εργασίας Ελληνικής Καρδιολογικής Εταιρείας Ιωάννινα,

More information

The Doppler Examination. Katie Twomley, MD Wake Forest Baptist Health - Lexington

The Doppler Examination. Katie Twomley, MD Wake Forest Baptist Health - Lexington The Doppler Examination Katie Twomley, MD Wake Forest Baptist Health - Lexington OUTLINE Principles/Physics Use in valvular assessment Aortic stenosis (continuity equation) Aortic regurgitation (pressure

More information

Echo in Pulmonary HTN

Echo in Pulmonary HTN Echo in Pulmonary HTN Steven A. Goldstein MD FACC FASE Professor of Medicine Georgetown University Medical Center MedStar Heart Institute Washington Hospital Center Monday, October 10, 2017 Pulmonary Artery

More information

Imaging in Heart Failure: A Multimodality Approach. Thomas Ryan, MD

Imaging in Heart Failure: A Multimodality Approach. Thomas Ryan, MD Imaging in Heart Failure: A Multimodality Approach Thomas Ryan, MD Heart Failure HFrEF HFpEF EF50% Lifetime risk 20% Prevalence 6M Americans Societal costs - $30B 50% 5-year survival 1 Systolic

More information

Tissue Doppler and Strain Imaging

Tissue Doppler and Strain Imaging Tissue Doppler and Strain Imaging Steven J. Lester MD, FRCP(C), FACC, FASE Relevant Financial Relationship(s) None Off Label Usage None 1 Objective way with which to quantify the minor amplitude and temporal

More information

Squeeze, Squeeze, Squeeze: The Importance of Right Ventricular Function and PH

Squeeze, Squeeze, Squeeze: The Importance of Right Ventricular Function and PH Squeeze, Squeeze, Squeeze: The Importance of Right Ventricular Function and PH Javier Jimenez MD PhD FACC Director, Advanced Heart Failure and Pulmonary Hypertension Miami Cardiac & Vascular Institute

More information

Advanced imaging of the left atrium - strain, CT, 3D, MRI -

Advanced imaging of the left atrium - strain, CT, 3D, MRI - Advanced imaging of the left atrium - strain, CT, 3D, MRI - Monica Rosca, MD Carol Davila University of Medicine and Pharmacy, Bucharest, Romania Declaration of interest: I have nothing to declare Case

More information

Echocardiography. Guidelines for Valve and Chamber Quantification. In partnership with

Echocardiography. Guidelines for Valve and Chamber Quantification. In partnership with Echocardiography Guidelines for Valve and Chamber Quantification In partnership with Explanatory note & references These guidelines have been developed by the Education Committee of the British Society

More information

E/Ea is NOT an essential estimator of LV filling pressures

E/Ea is NOT an essential estimator of LV filling pressures Euroecho Kopenhagen Echo in Resynchronization in 2010 E/Ea is NOT an essential estimator of LV filling pressures Wilfried Mullens, MD, PhD December 10, 2010 Ziekenhuis Oost Limburg Genk University Hasselt

More information

Tissue Doppler and Strain Imaging

Tissue Doppler and Strain Imaging Tissue Doppler and Strain Imaging Steven J. Lester MD, FRCP(C), FACC, FASE Relevant Financial Relationship(s) None Off Label Usage None 1 Objective way with which to quantify the minor amplitude and temporal

More information

New aspects of Echocardiography in Hypertensive Heart Disease. Fausto J. Pinto, MD, PhD, FESC, FACC, FASE

New aspects of Echocardiography in Hypertensive Heart Disease. Fausto J. Pinto, MD, PhD, FESC, FACC, FASE New aspects of Echocardiography in Hypertensive Heart Disease Fausto J. Pinto, MD, PhD, FESC, FACC, FASE Progressive increase in cardiovascular morbidity (left) and all-cause mortality (right) rates

More information

Left atrial function. Aliakbar Arvandi MD

Left atrial function. Aliakbar Arvandi MD In the clinic Left atrial function Abstract The left atrium (LA) is a left posterior cardiac chamber which is located adjacent to the esophagus. It is separated from the right atrium by the inter-atrial

More information

3 : 25. S K Parashar, New Delhi. Systolic HF

3 : 25. S K Parashar, New Delhi. Systolic HF 3 : 25 Role of Echo-Doppler in Heart Failure The impact of heart failure (HF) on the global health care community is well recognized. Moreover the incidence and prevalence of HF is increasing, both in

More information

HEMODYNAMIC ASSESSMENT

HEMODYNAMIC ASSESSMENT HEMODYNAMIC ASSESSMENT INTRODUCTION Conventionally hemodynamics were obtained by cardiac catheterization. It is possible to determine the same by echocardiography. Methods M-mode & 2D echo alone can provide

More information

Echocardiography: Guidelines for Valve Quantification

Echocardiography: Guidelines for Valve Quantification Echocardiography: Guidelines for Echocardiography: Guidelines for Chamber Quantification British Society of Echocardiography Education Committee Richard Steeds (Chair), Gill Wharton (Lead Author), Jane

More information

Assessment of LV systolic function

Assessment of LV systolic function Tutorial 5 - Assessment of LV systolic function Assessment of LV systolic function A knowledge of the LV systolic function is crucial in the undertanding of and management of unstable hemodynamics or a

More information

COMPLEX CONGENITAL HEART DISEASE: WHEN IS IT TOO LATE TO INTERVENE?

COMPLEX CONGENITAL HEART DISEASE: WHEN IS IT TOO LATE TO INTERVENE? COMPLEX CONGENITAL HEART DISEASE: WHEN IS IT TOO LATE TO INTERVENE? Aurora S. Gamponia, MD, FPPS, FPCC, FPSE OBJECTIVES Identify complex congenital heart disease at high risk or too late for intervention

More information

22 nd Annual Conference of the Saudi Heart Association Riyadh, Saudi Arabia

22 nd Annual Conference of the Saudi Heart Association Riyadh, Saudi Arabia 22 nd Annual Conference of the Saudi Heart Association Riyadh, Saudi Arabia New Echocardiographic Modalities to Evaluate Ventricular Function in Congenital Heart Disease: Tissue Doppler & Strain Rate Imaging

More information

PROSTHETIC VALVE BOARD REVIEW

PROSTHETIC VALVE BOARD REVIEW PROSTHETIC VALVE BOARD REVIEW The correct answer D This two chamber view shows a porcine mitral prosthesis with the typical appearance of the struts although the leaflets are not well seen. The valve

More information

Index of subjects. effect on ventricular tachycardia 30 treatment with 101, 116 boosterpump 80 Brockenbrough phenomenon 55, 125

Index of subjects. effect on ventricular tachycardia 30 treatment with 101, 116 boosterpump 80 Brockenbrough phenomenon 55, 125 145 Index of subjects A accessory pathways 3 amiodarone 4, 5, 6, 23, 30, 97, 102 angina pectoris 4, 24, 1l0, 137, 139, 140 angulation, of cavity 73, 74 aorta aortic flow velocity 2 aortic insufficiency

More information

Adel Hasanin Ahmed 1

Adel Hasanin Ahmed 1 Adel Hasanin Ahmed 1 PERICARDIAL DISEASE The pericardial effusion ends anteriorly to the descending aorta and is best visualised in the PLAX. PSAX is actually very useful sometimes for looking at posterior

More information

Das recht Ventrikel ist auch noch da! RV function The RV operates as. Physiology Not very sensitive to preload Good compliance of the free wall

Das recht Ventrikel ist auch noch da! RV function The RV operates as. Physiology Not very sensitive to preload Good compliance of the free wall Das recht Ventrikel ist auch noch da! I.Michaux Intensive Care Medicine University Hospital CHU UCL Namur Mont-Godinne Belgium RV function The RV operates as a low pressure, volume pump, moving the blood

More information

Right Heart Hemodynamics: Echo-Cath Discrepancies

Right Heart Hemodynamics: Echo-Cath Discrepancies Department of cardiac, thoracic and vascular sciences University of Padua, School of Medicine Padua, Italy Right Heart Hemodynamics: Echo-Cath Discrepancies Luigi P. Badano, MD, PhD, FESC, FACC **Dr. Badano

More information

Left atrial mechanical function and stiffness in patients with atrial septal aneurysm: A speckle tracking study

Left atrial mechanical function and stiffness in patients with atrial septal aneurysm: A speckle tracking study ORIGINAL ARTICLE Cardiology Journal 2015, Vol. 22, No. 5, 535 540 DOI: 10.5603/CJ.a2015.0033 Copyright 2015 Via Medica ISSN 1897 5593 Left atrial mechanical function and stiffness in patients with atrial

More information

가천의대길병원소아심장과최덕영 PA C IVS THE EVALUATION AND PRINCIPLES OF TREATMENT STRATEGY

가천의대길병원소아심장과최덕영 PA C IVS THE EVALUATION AND PRINCIPLES OF TREATMENT STRATEGY 가천의대길병원소아심장과최덕영 PA C IVS THE EVALUATION AND PRINCIPLES OF TREATMENT STRATEGY PA c IVS (not only pulmonary valve disease) Edwards JE. Pathologic Alteration of the right heart. In: Konstam MA, Isner M, eds.

More information

Φωτεινή Α. Λαζαρίδου Επιμελήτρια Α Γενικό Νοσοκομείο Αγιος Παύλος, Θεσσαλονίκη

Φωτεινή Α. Λαζαρίδου Επιμελήτρια Α Γενικό Νοσοκομείο Αγιος Παύλος, Θεσσαλονίκη 17 ο Πανελλήνιο Καρδιολογικό Συνέδριο ΚΕΒΕ Θεσσαλονίκη, 24-26 Μαϊου 2018 Στρογγυλό τραπέζι: Κλινικά προβλήματα στην πνευμονική υπέρταση Φωτεινή Α. Λαζαρίδου Επιμελήτρια Α Γενικό Νοσοκομείο Αγιος Παύλος,

More information

Right Ventricular Strain in Normal Healthy Adult Filipinos: A Retrospective, Cross- Sectional Pilot Study

Right Ventricular Strain in Normal Healthy Adult Filipinos: A Retrospective, Cross- Sectional Pilot Study Right Ventricular Strain in Normal Healthy Adult Filipinos: A Retrospective, Cross- Sectional Pilot Study By Julius Caesar D. de Vera, MD Jonnah Fatima B. Pelat, MD Introduction Right ventricle contributes

More information

Ejection across stenotic aortic valve requires a systolic pressure gradient between the LV and aorta. This places a pressure load on the LV.

Ejection across stenotic aortic valve requires a systolic pressure gradient between the LV and aorta. This places a pressure load on the LV. Valvular Heart Disease Etiology General Principles Cellular and molecular mechanism of valve damage Structural pathology Functional pathology - stenosis/regurgitation Loading conditions - pressure/volume

More information

Heart Failure in Women: Dr Goh Ping Ping Cardiologist Asian Heart & Vascular Centre

Heart Failure in Women: Dr Goh Ping Ping Cardiologist Asian Heart & Vascular Centre Heart Failure in Women: More than EF? Dr Goh Ping Ping Cardiologist Asian Heart & Vascular Centre Overview Review pathophysiology as it relates to diagnosis and management Rational approach to workup:

More information

Certificate in Clinician Performed Ultrasound (CCPU) Syllabus. Rapid Cardiac Echo (RCE)

Certificate in Clinician Performed Ultrasound (CCPU) Syllabus. Rapid Cardiac Echo (RCE) Certificate in Clinician Performed Ultrasound (CCPU) Syllabus Rapid Cardiac Echo (RCE) Purpose: Rapid Cardiac Echocardiography (RCE) This unit is designed to cover the theoretical and practical curriculum

More information

Impact of Nicorandil on Renal Function in Patients With Acute Heart Failure and Pre-Existing Renal Dysfunction

Impact of Nicorandil on Renal Function in Patients With Acute Heart Failure and Pre-Existing Renal Dysfunction Impact of Nicorandil on Renal Function in Patients With Acute Heart Failure and Pre-Existing Renal Dysfunction Masahito Shigekiyo, Kenji Harada, Ayumi Okada, Naho Terada, Hiroyoshi Yoshikawa, Akira Hirono,

More information

Advanced Applica,on of Point- of- Care Echocardiography in Cri,cal Care. Dr. Mark Tutschka Dr. Rob ArnAield

Advanced Applica,on of Point- of- Care Echocardiography in Cri,cal Care. Dr. Mark Tutschka Dr. Rob ArnAield Advanced Applica,on of Point- of- Care Echocardiography in Cri,cal Care Dr. Mark Tutschka Dr. Rob ArnAield OBJECTIVES Provide an overview of common advanced echocardiographic techniques suitable for use

More information

Ιπποκράτειες μέρες καρδιολογίας Θεσσαλονίκη, 9-10 Μαρτίου Φωτεινή Α. Λαζαρίδου Επιμελήτρια Α Γενικό Νοσοκομείο Αγιος Παύλος, Θεσσαλονίκη

Ιπποκράτειες μέρες καρδιολογίας Θεσσαλονίκη, 9-10 Μαρτίου Φωτεινή Α. Λαζαρίδου Επιμελήτρια Α Γενικό Νοσοκομείο Αγιος Παύλος, Θεσσαλονίκη Ιπποκράτειες μέρες καρδιολογίας Θεσσαλονίκη, 9-10 Μαρτίου 2018 Φωτεινή Α. Λαζαρίδου Επιμελήτρια Α Γενικό Νοσοκομείο Αγιος Παύλος, Θεσσαλονίκη RV shape Triangular shape in frontal plane crescent shape in

More information

DECLARATION OF CONFLICT OF INTEREST

DECLARATION OF CONFLICT OF INTEREST DECLARATION OF CONFLICT OF INTEREST ESC Congress 2011 Pathophysiology of HFPEF Vascular Remodeling & Pulmonary Hypertension Carolyn S.P. Lam MBBS, MRCP, MS Case Presentation 81 yo woman with dyspnoea &

More information

Echocardiographic Evaluation of the Cardiomyopathies. Stephanie Coulter, MD, FACC, FASE April, 2016

Echocardiographic Evaluation of the Cardiomyopathies. Stephanie Coulter, MD, FACC, FASE April, 2016 Echocardiographic Evaluation of the Cardiomyopathies Stephanie Coulter, MD, FACC, FASE April, 2016 Cardiomyopathies (CMP) primary disease intrinsic to cardiac muscle Dilated CMP Hypertrophic CMP Infiltrative

More information

OPTIMIZING ECHO ACQUISTION FOR STRAIN AND DIASTOLOGY

OPTIMIZING ECHO ACQUISTION FOR STRAIN AND DIASTOLOGY OPTIMIZING ECHO ACQUISTION FOR STRAIN AND DIASTOLOGY October 8, 2017 Deborah Agler, ACS, RDCS, FASE Coordinator of Education and Training Cleveland Clinic General Principles Diastology Clinical Data Heart

More information

Pulmonary Hypertension: Follow-up in adolescence and adults

Pulmonary Hypertension: Follow-up in adolescence and adults Pulmonary Hypertension: Follow-up in adolescence and adults Helmut Baumgartner Westfälische Wilhelms-Universität Münster Adult Congenital and Valvular Heart Disease Center University of Muenster Germany

More information

Objectives. Diastology: What the Radiologist Needs to Know. LV Diastolic Function: Introduction. LV Diastolic Function: Introduction

Objectives. Diastology: What the Radiologist Needs to Know. LV Diastolic Function: Introduction. LV Diastolic Function: Introduction Objectives Diastology: What the Radiologist Needs to Know. Jacobo Kirsch, MD Cardiopulmonary Imaging, Section Head Division of Radiology Cleveland Clinic Florida Weston, FL To review the physiology and

More information

Chapter 52 Diastolic Stress Echocardiography

Chapter 52 Diastolic Stress Echocardiography Chapter 52 Diastolic Stress Echocardiography SATISH C. GOVIND AASHA S. GOPAL ANATOLI KIOTSEKOGLOU SAMIR K. SAHA PHYSIOLOGY OF DIASTOLE Left ventricular (LV) diastole can typically be defined as a phase

More information

The right ventricle in chronic heart failure

The right ventricle in chronic heart failure The right ventricle in chronic heart failure ESC 2012 Christian Opitz, Berlin There are no conflicts of interest relevant to this presentation Percent of Population Prevalence of Heart Failure by Age and

More information

L ecocardiografia nello Scompenso Cardiaco Acuto e cronico: vecchi dogmi e nuovi trends.

L ecocardiografia nello Scompenso Cardiaco Acuto e cronico: vecchi dogmi e nuovi trends. V SESSIONE SCOMPENSO CARDIACO 2015 Genova, 13-14 Novembre 2015 L ecocardiografia nello Scompenso Cardiaco Acuto e cronico: vecchi dogmi e nuovi trends. Gian Paolo Bezante, MD, FACC UOC Clinica di Malattie

More information

Velocity, strain and strain rate: Doppler and Non-Doppler methods. Thoraxcentre, Erasmus MC,Rotterdam

Velocity, strain and strain rate: Doppler and Non-Doppler methods. Thoraxcentre, Erasmus MC,Rotterdam Velocity, strain and strain rate: Doppler and Non-Doppler methods J Roelandt J. Roelandt Thoraxcentre, Erasmus MC,Rotterdam Basics of tissue Doppler imaging Instantaneous annular velocity profiles IVCT

More information

Aortic valve Stenosis: Insights in the evaluation of LV function. Erwan DONAL Cardiologie CHU Rennes

Aortic valve Stenosis: Insights in the evaluation of LV function. Erwan DONAL Cardiologie CHU Rennes Aortic valve Stenosis: Insights in the evaluation of LV function Erwan DONAL Cardiologie CHU Rennes erwan.donal@chu-rennes.fr Preload Afterload Myocardial Fiber Shortening Circumferential Longitudinal

More information

LA Function analysis Marcia Barbosa Vice Presidente - Brazilian Soc of Cardiology President-elect - Interamerican Soc of Cardiology

LA Function analysis Marcia Barbosa Vice Presidente - Brazilian Soc of Cardiology President-elect - Interamerican Soc of Cardiology LA Function analysis Marcia Barbosa Vice Presidente - Brazilian Soc of Cardiology President-elect - Interamerican Soc of Cardiology Belo Horizonte Brazil DECLARATION OF CONFLICT OF INTEREST Nothing to

More information

HISTORY. Question: How do you interpret the patient s history? CHIEF COMPLAINT: Dyspnea of two days duration. PRESENT ILLNESS: 45-year-old man.

HISTORY. Question: How do you interpret the patient s history? CHIEF COMPLAINT: Dyspnea of two days duration. PRESENT ILLNESS: 45-year-old man. HISTORY 45-year-old man. CHIEF COMPLAINT: Dyspnea of two days duration. PRESENT ILLNESS: His dyspnea began suddenly and has been associated with orthopnea, but no chest pain. For two months he has felt

More information

Ejection across stenotic aortic valve requires a systolic pressure gradient between the LV and aorta. This places a pressure load on the LV.

Ejection across stenotic aortic valve requires a systolic pressure gradient between the LV and aorta. This places a pressure load on the LV. Valvular Heart Disease General Principles Etiology Cellular and molecular mechanism of valve damage Structural pathology Functional pathology - stenosis/regurgitation Loading conditions - pressure/volume

More information

Adult Echocardiography Examination Content Outline

Adult Echocardiography Examination Content Outline Adult Echocardiography Examination Content Outline (Outline Summary) # Domain Subdomain Percentage 1 2 3 4 5 Anatomy and Physiology Pathology Clinical Care and Safety Measurement Techniques, Maneuvers,

More information

Novel Echocardiographic Techniques in the Diagnosis of Heart Failure

Novel Echocardiographic Techniques in the Diagnosis of Heart Failure 1 Novel Echocardiographic Techniques in the Diagnosis of Heart Failure PhD Thesis By Réka Faludi MD Head of the Doctoral School: Prof. Sámuel Komoly MD, DSc Head of the Doctoral Program: Prof. Erzsébet

More information

Diastology State of The Art Assessment

Diastology State of The Art Assessment Diastology State of The Art Assessment Dr. Mohammad AlGhamdi Assistant professor, KSAU-HS Consultant Cardiologist King AbdulAziz Cardiac Center Ministry of National Guard Health Affairs Diagnostic Clinical

More information

Effect of Heart Rate on Tissue Doppler Measures of E/E

Effect of Heart Rate on Tissue Doppler Measures of E/E Cardiology Department of Bangkok Metropolitan Administration Medical College and Vajira Hospital, Bangkok, Thailand Abstract Background: Our aim was to study the independent effect of heart rate (HR) on

More information

Restrictive Cardiomyopathy

Restrictive Cardiomyopathy ESC Congress 2011, Paris Imaging Unusual Causes of Cardiomyopathy Restrictive Cardiomyopathy Kazuaki Tanabe, MD, PhD Professor of Medicine Chair, Division of Cardiology Izumo, Japan I Have No Disclosures

More information

Choose the grading of diastolic function in 82 yo woman

Choose the grading of diastolic function in 82 yo woman Question #1 Choose the grading of diastolic function in 82 yo woman E= 80 cm/s A= 70 cm/s LAVI < 34 ml/m 2 1= Grade 1 2= Grade 2 3= Grade 3 4= Normal 5= Indeterminate 2018 MFMER 3712003-1 Choose the grading

More information

Fig.1 Normal appearance of RV in SAX:

Fig.1 Normal appearance of RV in SAX: Tutorial 7 - Assessment of the right heart Assessment of the Right heart The right heart assessment clinically and echocardiographically is not a very important part of mainstream cardiology. In the ICU,

More information

Rest and Exercise Echocardiography in Hypertrophic Cardiomyopathy: Determinants of Exercise Peak Gradient and Predictors of Outcome

Rest and Exercise Echocardiography in Hypertrophic Cardiomyopathy: Determinants of Exercise Peak Gradient and Predictors of Outcome Rest and Exercise Echocardiography in Hypertrophic Cardiomyopathy: Determinants of Exercise Peak Gradient and Predictors of Outcome G. Deswarte, AS. Polge, N. Lamblin, A. Millaire, M. Richardson, C. Bauters,

More information

Assessment of right ventricular contraction by speckle tracking echocardiography in pulmonary hypertension patients.

Assessment of right ventricular contraction by speckle tracking echocardiography in pulmonary hypertension patients. Biomedical Research 2017; 28 (1): 173-177 ISSN 0970-938X www.biomedres.info Assessment of right ventricular contraction by speckle tracking echocardiography in pulmonary hypertension patients. Yudong Peng,

More information

It has been more than a decade since

It has been more than a decade since doi: 10.1111/j.1751-7133.2010.00192.x R EVIEW P APER Differentiating Pulmonary Arterial and Pulmonary Venous and the Implications for Therapy It has been more than a decade since the Second World Symposium

More information