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Clinical application of motion and deformation parameters.

Clinical application of motion and deformation parameters. Global Systolic Function. Measurement of longitudinal shortening of the left ventricle to assess LV-function. (mitral annular descent, which can be evaluated by TDI at different sites.

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Clinical application of motion and deformation parameters.

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  1. Clinical application of motion and deformation parameters.

  2. Global Systolic Function. • Measurement of longitudinal shortening of the left ventricle to assess LV-function. (mitral annular descent, which can be evaluated by TDI at different sites. • Peak systolic velocities by tissue Doppler imaging in systolic heart failure

  3. The 6-site peak mitral annular descent velocity average > 5.4 cm/s was 88% sensitive and 97% specific for ejection fraction > 50%. The peak mitral annular descent velocity from the apical 4-chamber view (average from inferoseptal and lateral sites) correlated most closely with the LV ejection fraction . Vijay K. Gulati et al American Journal of Cardiology,1996; 979-984,

  4. Normal values for pulsed DTI velocities recording inthe apical views at basal segments of the left ventricle

  5. Results-Total mortality was 22.7% (41/181), and was highly significantly (P= 0.001) related to atrioventricular plane displacement. Mortality within prospectively defined categories of displacement was: > 10.0 mm, 0%(0/19); 8.2 to 9.9 mm, 10.3% (3/29); 6.4 to 8.1 mm, 19.4% (12/62); and < 6.4 mm, 36.6% (26/71). Conclusions-Mortality in heart failure is strongly related to atrioventricular plane displacement. Mortality is significantly higher when AVPD is < 10 mm. Substantial mortality increase when AVPD is < 7 mm. Heart 1997; 78; 230-236

  6. Incremental value of Em < 3 and E/Em > 15 in predicting long-term (median, 48 months) cardiac mortality.

  7. LV Diastolic Function • Normal Values: • In general, septal e’ > 8 cm/s and lateral e’ >10 cm/s are usually observed in normal subject, and are reduced in patients with impaired LV relaxation and increased LV filling pressures. • Normal values of strain and SR are yet to be established.

  8. Assessment of Diastolic Function Carolyn Y. Ho et al Circulation 2006;113;e396-e398

  9. Estimation of LV Filling Pressures. • LV filling pressures are correlated with the ratio of the mitral inflow E wave to the tissue Doppler Ea wave (E/Ea). • This relation is based on Ea velocities that “correct” E-wave velocities for the impact of relaxation. • The E/Ea ratio can be used to estimate LV filling pressures as follows: • Lateral E/ Ea > 10 or septal E/Ea >15 is correlated with an elevated LV end-diastolic pressure, • E/Ea < 8 is correlated with a normal LV end-diastolic pressure.

  10. TDI annular velocities.

  11. Age adjusted normal cut offs for selected diastolic parameters.

  12. The ratio of E to SRIVR was useful in predicting LV filling pressure in patients in whom the E/e’ ratio was inconclusive • It was more accurate than E/e’ in patients with normal EFs and those with regional dysfunction. • SRIVR was shown to have an incremental prognostic value in patients with ST-segment elevation myocardial infarction.

  13. Assessment of right ventricular function. • Systolic long axis velocity measurement of the free wall tricuspid annulus is useful and accurate to assess RV systolic function: • Systolic LA velocity > 12 cm/s  N RV EF > 55% • 9-12 cm /s  moderately reduced RVEF > 30-55% • < 9 cm/s  severely reduced RV EF < 30 %

  14. Assessment of RV systolic function by Tei index ET IVCT IVRT

  15. Assessment of LV systolic function in asymptomatic severe aortic regurgitation • TDE may be helpful for identifying subclinical left ventricular dysfunction in patients with chronic severe aortic regurgitation who are asymptomatic but may be candidates for surgery. • In one study of 21 asymptomatic patients, reduced long axis contraction, as measured by mitral annular excursion and systolic velocity, were indicators of subclinical left ventricular dysfunction. • A systolic annular excursion <12 mm • a resting mitral annular velocity <9.5 cm/sec were the best indicators of subclinical left ventricular dysfunction.

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