Diastolic Dysfunction as Diagnosed and Quantified by Echoca - PowerPoint Presentation

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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 CycleSlide4
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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

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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?

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What is Diastolic Dysfunction?Slide11
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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?