LAM 1965AO 0713 For BrokerDealer Use Only Diastole and Systole Diastole The normal rhythmically occurring relaxation and dilatation of the heart chambers especially the ventricles during which they fill with blood ID: 264390
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Slide1
Diastolic Dysfunction as Diagnosed and Quantified by Echocardiography
LAM-
1965AO
(07/13) For Broker/Dealer Use OnlySlide2
Diastole and Systole
Diastole: The normal rhythmically occurring relaxation and dilatation of the heart chambers, especially the ventricles, during which they fill with blood.Systole: The contraction, or period of contraction, of the heart, especially of the ventricles, during which blood is forced into the aorta and pulmonary artery.Slide3
Cardiac CycleSlide4Slide5
What is Diastolic Dysfunction?
Changes in the ventricle which may result in impaired relaxation, reduced compliance and elevated pressuresDiastolic Dysfunction ≠ Diastolic Heart FailureSlide6
What is Diastolic Dysfunction?
Who is more likely to develop DD? Elderly*
Women
Obese
What diseases are more likely to produce DD?
HTN
LVH
CAD
VHD (AS)
Text book Example:
Older lady overweight with long history of hypertension with exercise intolerance
Slide7
What is Diastolic Dysfunction?
3 Stages to Diastolic Dysfunction
I) Impaired Relaxation
II) Pseudonormal
III) Restrictive
Primary measurements include peak E &
A transmitral
velocities, E/A ratio, DT (Deceleration Time) and IVRT (Isovolumetric Relaxation Time)
Additional measurements E/e
’,
LA volume
index, Pulmonary Vein Flow ( S/D & AR) and
Vp (Propagation Velocity) Slide8
What is Diastolic Dysfunction?
Figure 2 Doppler echocardiogram shows normal pattern of diastolic filling. Opening of the mitral value produces increased flow velocity through the valve annulus, which is represented as a large E wave (E). During late diastolic filling, the transmitral pressure gradient increases once again, with atrial contraction producing a smaller A wave (A).
(3)Slide9
What is Diastolic Dysfunction?
Slide10
What is Diastolic Dysfunction?Slide11Slide12
What is Diastolic Dysfunction?
I: impaired relaxation, II: moderate diastolic dysfunction (pseudonormal), III: restrictive left ventricular filling (impaired LV compliance), ECG: electrocardiogram, MI: mitral inflow, MA: mitral annular velocities, PVF: pulmonary venous flow, Vp: velocity of flow progression, LA: left atrium, PASP: pulmonary artery systolic pressure. Slide13
What is Diastolic Dysfunction?
1st use E/A, DT, and IVRT2nd use E/e
’ (<8,8-15,>15)
and LA vol
index (< 28 ml/M
2
WNL and > 34 ml/M
2
increased mortality)
3
rd
use Pulmonary Vein Flow ( S/D & AR) and
Vp (Propagation Velocity) Slide14
What is Diastolic Dysfunction?
Normal E/A Ratio (>1)Good: < 60 yo, no risk factors, no evidence of increased filling pressures ( E/e’ > 15, S<D, inc AR,
dec
Vp )
Not Good: > 70 yo with risk factors (HTN/LVH, CAD, ♀ ), evidence of increased filling pressures
E/A < 1 ( Grade I DD, Impaired Relaxation)
NBD: > 70 yo and no HTN/LVH or CAD
BD: < 50 yo with HTN/LVH or CAD
Grade II DD, Pseudonormal and LA vol index (> 34 ml/M
2
)
BAD ( until proven otherwise)
Grade III or IV, Restrictive
BAD
BAD
BADSlide15
Diastolic Dysfunction Case Study
74 yo male applying for $5 mil , no h/o HTN, heart disease , diabetes or cancer6’ 0” , 185 lbs, 125/82 mmHg , 62 regLabs and EKG WNLAPS: 2012 echo….LV size and function WNL , EF 65%, LVPWd 1.1 cm, R & L atrium WNL, Grade I DD, no significant valvular disease….GXT: exercised 13 min to 14 METS, no ischemic changes
Offer?Slide16
Diastolic Dysfunction Case Study
72 yo female applying for $5 mil , long h/o HTN, no heart disease , diabetes or cancer5’2” , 220 lbs, 154/92 mmHg , 92 regLabs WNL except NTproBNP 320 pg/ml and EKG LAD, LVH & LAEAPS: 2012 echo….LV size and function WNL , EF 65%,
LVPWd 1.6
cm, L atrium 5.2 cm, E:A 2.2, E/e’ 20, no significant valvular disease….GXT: exercised 3 min to 4 METS, no ischemic changes
Offer?