Evaluation of Diastolic Dysfunction by Echocardiogram超声心动图评价舒张功能不全.ppt

Color M-mode Flow Propagation In apical 4 chamber view Align M-mode cursor through LV apex and orifice of MV Apply Color Doppler Switch to M-mode acquisition Decrease Nyquist limit until color inflow shows line of aliasing Tables of normative values for children are available Tables of normative values for children are available Let’s apply our data Let’s apply our data Let’s apply our data Vs Strength of Filling In a recent article by Stewart et al., JACC Imaging 2011 Found that in addition to a decreased filling velocity (Vp) with diastolic dysfunction, the velocity further slowed closer to the MV than the apex (Li) Vs= Vp x Li Found this measure to have better correlation to gold-standard than Vp alone Would like to see used with other measures to further strengthen accuracy and separation of abnormal states Looking at Vp To summarize our non-invasive data So by our echo data… I would classify this patient as having RESTRICTIVE PHYSIOLOGY He just so happened to have been cathed just before I obtained these measures… I did not know these results Disease states Hypertrophic cardiomyopathy Chronic disease states HOCM Abnormalities of E/Ea, color M-mode flow propagation, and diastolic strain rates have correlated with abnormal relaxation and predict LV filling pressures. TDI (DTI) has been found to be predictive of adverse outcomes E/Ea 12 predicted risk for SCD, Cardiac Arrest, and VT Those without, events had range 7.4-11.2 Those with symptoms had ratio higher compared to those without (11.9 vs 8.1) Distinguishing HOCM from Athletic Heart Diastolic TDI annular patterns, IVRT, and LA volume have identified HOCM in absence of pathologic changes Early diastolic TDI velocities (Ea) Athletes: normal to increased HOCM: consistently decreased, often Ea/Aa 1. Children with Chronic Dz’s Renal failure Those on dialysis had changes on echo compared to normal controls: Increased LV mass with preserved systolic function Evidence of diastolic dysfunction: higher E’s,