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Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory

IL CALCOLO DEL RAPPORTO E/e’ VA ROUTINARIAMENTE INSERITO IN OGNI REPORT IN QUANTO METODO AFFIDABILE PER IL RILIEVO DELLA PRESSIONE TELEDIASTOLICA E LA GESTIONE CLINICA DEL PAZIENTE?. Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory

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Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory

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  1. IL CALCOLO DEL RAPPORTO E/e’ VA ROUTINARIAMENTE INSERITO IN OGNI REPORT IN QUANTO METODO AFFIDABILE PER IL RILIEVO DELLA PRESSIONE TELEDIASTOLICA E LA GESTIONE CLINICA DEL PAZIENTE? Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory Sheikh Khalifa Medical City – Abu Dhabi, U.A.E.

  2. TO THE POINT • What is E/e’? • Determination of LV filling pressure • Evaluation of pts (with HF) E/e’ and LV filling pressure l September 26, 2014 l 2

  3. MITRAL INFLOW VELOCITY E wave • LV relaxation kinetics • LA pressure E/e’ and LV filling pressure l September 26, 2014 l 3

  4. PHYSIOLOGY OF LV FILLING Little and Oh. Circulation 2009;120:802-809. E/e’ and LV filling pressure l September 26, 2014 l 4

  5. RESTRICTIVE LV FILLING Masutani et al. Circulation 2008;117:1550-1554. Presentation Title l September 26, 2014 l 5

  6. DOPPLER FLOW PARAMETERS AND LVDP Variable r E/A 0.59 DT 0.48 PVs/PVd 0.31 Pva-Mva 0.29 ∆ E/A 0.43 Ommen et al. Circulation 2000;102:1788-1794. E/e’ and LV filling pressure l September 26, 2014 l 6

  7. DOPPLER FLOW PARAMETERS AND LVDP Variable r EF >50% EF <50% E/A 0.59 0.25 0.46 DT 0.48 0.17 0.60 PVs/PVd 0.31 0.03 0.23 Pva-Mva 0.29 0.39 0.12 ∆ E/A 0.43 0.36 0.30 Ommen et al. Circulation 2000;102:1788-1794. E/e’ and LV filling pressure l September 26, 2014 l 7

  8. DOPPLER FLOW PARAMETERS AND LVDP 100 80 60 Correctly classified, % 40 20 0 PVs/PVd E/A DT ∆ E/A Pva-MVa Ommen et al. Circulation 2000;102:1788-1794. Presentation Title l September 26, 2014 l 8

  9. DOPPLER FLOW PARAMETERS AND LVDP 100 80 60 Correctly classified, % 40 20 0 PVs/PVd E/A DT ∆ E/A Pva-MVa Ommen et al. Circulation 2000;102:1788-1794. Presentation Title l September 26, 2014 l 9

  10. LV DIASTOLIC FUNCTION Mitral flow Doppler alone is not enough! E/e’ and LV filling pressure l September 26, 2014 l 10

  11. MITRAL ANNULAR VELOCITY e’ wave • LV relaxation kinetics E/e’ and LV filling pressure l September 26, 2014 l 11

  12. WHAT IS e’? • It behaves as an index of LV relaxation • Significant inverse correlation with tau • No change with preload alterations E/e’ and LV filling pressure l September 26, 2014 l 12

  13. WHY E/e’? • LV relaxation kinetics • LA pressure E e’ • LV relaxation kinetics E/e’ and LV filling pressure l September 26, 2014 l 14

  14. WHY E/e’? • LV relaxation kinetics • LA pressure E e’ • LV relaxation kinetics E/e’ and LV filling pressure l September 26, 2014 l 15

  15. RESTRICTIVE LV FILLING Masutani et al. Circulation 2008;117:1550-1554. Presentation Title l September 26, 2014 l 16

  16. DIASTOLIC MITRAL ANNULAR VELOCITY Normal Normal HF HF Hasegawa et al. J Am Coll Cardiol 2003;41;1590-7. E/e’ and LV filling pressure l September 26, 2014 l 18

  17. DIASTOLIC PARAMETERS AND TAU () E (ml/sec) Peak e’ (mm/sec) Hasegawa et al. J Am Coll Cardiol 2003;41;1590-7. E/e’ and LV filling pressure l September 26, 2014 l 19

  18. TO THE POINT E/e’ and LV filling pressure l September 26, 2014 l 20 What is E/e’ Determination of LV filling pressure Evaluation of pts with HF

  19. ASSESSMENT OF LV FILLING PRESSURE Ommen et al. Circulation 2000;102:1788-1794. E/e’ and LV filling pressure l September 26, 2014 l 21

  20. LV FILLING PRESSURE DEFINED BY E/e’ EF <50% EF >50% LVDP (mmHg) E/e’ <8 E/e’ >15 Ommen et al. Circulation 2000;102:1788-1794. E/e’ and LV filling pressure l September 26, 2014 l 22

  21. LV FILLING PRESSURE DEFINED BY E/e’ EF <50% EF >50% LVDP (mmHg) E/e’ 8÷15 Ommen et al. Circulation 2000;102:1788-1794. E/e’ and LV filling pressure l September 26, 2014 l 23

  22. LV FILLING PRESSURE DEFINED BY E/e’ Flow Doppler -ve PVa-Mva >30 ms Valsalva +ve >1 variable +ve X LVDP (mmHg) X X X X E/e’ 8÷15 Ommen et al. Circulation 2000;102:1788-1794. E/e’ and LV filling pressure l September 26, 2014 l 24

  23. LV FILLING PRESSURE DEFINED BY E/e’ PVa-Mva >30 ms Valsalva +ve >1 variable +ve X LVDP (mmHg) X X X X E/e’ 8÷15 Ommen et al. Circulation 2000;102:1788-1794. E/e’ and LV filling pressure l September 26, 2014 l 25

  24. LV FILLING PRESSURE DEFINED BY E/e’ Flow Doppler -ve LVDP (mmHg) X X E/e’ 8÷15 Ommen et al. Circulation 2000;102:1788-1794. E/e’ and LV filling pressure l September 26, 2014 l 26

  25. ONE SIZE FITS ALL! E/e’ and LV filling pressure l September 26, 2014 l 27

  26. CONSTRICTIVE PERICARDITIS PCWP 31 mmHg E/e’ 5 PCWP 18 mmHg E/e’ 17 Ha et al. Circulation 2001;104:976-978. E/e’ and LV filling pressure l September 26, 2014 l 29

  27. TO THE POINT E/e’ and LV filling pressure l September 26, 2014 l 30 What is E/e’ Determination of LV filling pressure Evaluation of pts with HF

  28. E/e’ and LV filling pressure l September 26, 2014 l 33

  29. Estimation of filling pressures in patients with normal EF E/e’ Sept E/e’ ≥15 or Lat E/e’ ≥12 or Aver E/e’ ≥13 E/e’ ≤8 (sept, lat, or average) E/e’ 9-14 LAV <34 ml/m2 Ar-A <0 ms Valsalva Δ E/A <0.5 PAS <30 mmHg IVRT/TE-e’ >2 LAV ≥34 ml/m2 Ar-A ≥30 ms Valsalva Δ E/A ≥0.5 PAS >35 mmHg IVRT/TE-e’ <2 Normal LAP Normal LAP LAP LAP E/e’ and LV filling pressure l September 26, 2014 l 34

  30. Estimation of filling pressures in patients with normal EF E/e’ and LV filling pressure l September 26, 2014 l 35

  31. E vel = 82 cm/sec e’ vel = 4 cm/sec E/e’ = 82/4 = 20.5 E/e’ and LV filling pressure l September 26, 2014 l 36

  32. Estimation of filling pressures in patients with normal EF E/e’ Sept E/e’ ≥15 or Lat E/e’ ≥12 or Aver E/e’ ≥13 E/e’ ≤8 (sept, lat, or average) E/e’ 9-14 LAV <34 ml/m2 Ar-A <0 ms Valsalva Δ E/A <0.5 PAS <30 mmHg IVRT/TE-e’ >2 LAV ≥34 ml/m2 Ar-A ≥30 ms Valsalva Δ E/A ≥0.5 PAS >35 mmHg IVRT/TE-e’ <2 Normal LAP Normal LAP LAP LAP E/e’ and LV filling pressure l September 26, 2014 l 37

  33. Estimation of filling pressures in patients with normal EF E/e’ Sept E/e’ ≥15 or Lat E/e’ ≥12 or Aver E/e’ ≥13 E/e’ ≤8 (sept, lat, or average) E/e’ 9-14 LAV <34 ml/m2 Ar-A <0 ms Valsalva Δ E/A <0.5 PAS <30 mmHg IVRT/TE-e’ >2 LAV ≥34 ml/m2 Ar-A ≥30 ms Valsalva Δ E/A ≥0.5 PAS >35 mmHg IVRT/TE-e’ <2 Normal LAP Normal LAP LAP LAP E/e’ and LV filling pressure l September 26, 2014 l 38

  34. Estimation of filling pressures in patients with normal EF E/e’ Sept E/e’ ≥15 or Lat E/e’ ≥12 or Aver E/e’ ≥13 E/e’ ≤8 (sept, lat, or average) E/e’ 9-14 LAV <34 ml/m2 Ar-A <0 ms Valsalva Δ E/A <0.5 PAS <30 mmHg IVRT/TE-e’ >2 LAV ≥34 ml/m2 Ar-A ≥30 ms Valsalva Δ E/A ≥0.5 PAS >35 mmHg IVRT/TE-e’ <2 Normal LAP Normal LAP LAP LAP E/e’ and LV filling pressure l September 26, 2014 l 39

  35. Estimation of filling pressures in patients with normal EF E/e’ Sept E/e’ ≥15 or Lat E/e’ ≥12 or Aver E/e’ ≥13 E/e’ ≤8 (sept, lat, or average) E/e’ 9-14 LAV <34 ml/m2 Ar-A <0 ms Valsalva Δ E/A <0.5 PAS <30 mmHg IVRT/TE-e’ >2 LAV ≥34 ml/m2 Ar-A ≥30 ms Valsalva Δ E/A ≥0.5 PAS >35 mmHg IVRT/TE-e’ <2 Normal LAP Normal LAP LAP LAP E/e’ and LV filling pressure l September 26, 2014 l 40

  36. Estimation of filling pressures in patients with depressed EF Mitral E/A E/A ’ ≥2, DT <150 ms E/A <1 and E ≤50 cm/sec E/A 1÷2, or E/A <1 and E >50 cm/sec E/e’ (average e’) <8 E/Vp <1.4 S/D >1 Ar-A <0 ms Valsalva Δ E/A <0.5 PAS <30 mmHg IVRT/TE-e’ >2 E/e’ (average e’) >15 E/Vp ≥2.5 S/D <1 Ar-A ≥30 ms Valsalva Δ E/A ≥0.5 PAS >35 mmHg IVRT/TE-e’ <2 E/e’ LAP LAP Normal LAP Normal LAP E/e’ and LV filling pressure l September 26, 2014 l 41

  37. E/e’ and LV filling pressure l September 26, 2014 l 42

  38. E/e’ and LV filling pressure l September 26, 2014 l 43

  39. VIZI PRIVATI, PUBBLICHE VIRTU’ E/e’ and LV filling pressure l September 26, 2014 l 44

  40. E/e’ and LV filling pressure l September 26, 2014 l 45

  41. E/e’ and LV filling pressure l September 26, 2014 l 46

  42. E/e’ and LV filling pressure l September 26, 2014 l 47

  43. SI FA, MA NON SI DICE … Dini FL et al. Eur J Echocardiogr 2010;11;703-710. E/e’ and LV filling pressure l September 26, 2014 l 48

  44. E/e’ and LV filling pressure l September 26, 2014 l 49

  45. IL CALCOLO DEL RAPPORTO E/e’ VA ROUTINARIAMENTE INSERITO IN OGNI REPORT IN QUANTO METODO AFFIDABILE PER IL RILIEVO DELLA PRESSIONE TELEDIASTOLICA E LA GESTIONE CLINICA DEL PAZIENTE? Pro: Alessandro Salustri Contro: Maurizio Galderisi Moderatori: Alfredo Zuppiroli Maurizio Galderisi Presentation Title l September 26, 2014 l 50

  46. E/e’ and LV filling pressure l September 26, 2014 l 51

  47. E/e’ and LV filling pressure l September 26, 2014 l 52

  48. Presentation Title l September 26, 2014 l 53

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