Post on 11-Jan-2016
description
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 SalustriCardiology Consultant
Head Noninvasive LaboratorySheikh Khalifa Medical City – Abu Dhabi, U.A.E.
•What is E/e’?
•Determination of LV filling pressure
•Evaluation of pts (with HF)
E/e’ and LV filling pressure l April 21, 2023 l 2
TO THE POINT
LV relaxation kinetics
LA pressure
MITRAL INFLOW VELOCITY
E wave
E/e’ and LV filling pressure l April 21, 2023 l 3
PHYSIOLOGY OF LV FILLING
Little and Oh. Circulation 2009;120:802-809.
E/e’ and LV filling pressure l April 21, 2023 l 4
Presentation Title l April 21, 2023 l 5
RESTRICTIVE LV FILLING
Masutani et al. Circulation 2008;117:1550-1554.
E/e’ and LV filling pressure l April 21, 2023 l 6
DOPPLER FLOW PARAMETERS AND LVDP
E/A 0.59
DT 0.48
PVs/PVd 0.31
Pva-Mva 0.29
∆ E/A 0.43
Variable
Ommen et al. Circulation 2000;102:1788-1794.
r
E/e’ and LV filling pressure l April 21, 2023 l 7
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
Variable EF >50% EF <50%
Ommen et al. Circulation 2000;102:1788-1794.
DOPPLER FLOW PARAMETERS AND LVDP
r
Presentation Title l April 21, 2023 l 8
∆ E/A Pva-MVa PVs/PVd
0
20
40
60
80
100
Ommen et al. Circulation 2000;102:1788-1794.
DOPPLER FLOW PARAMETERS AND LVDP
Co
rre
ctly
cla
ssifi
ed
, %
E/A DT
Presentation Title l April 21, 2023 l 9
E/A DT ∆ E/A Pva-MVa PVs/PVd
0
20
40
60
80
100
Co
rre
ctly
cla
ssifi
ed
, %
Ommen et al. Circulation 2000;102:1788-1794.
DOPPLER FLOW PARAMETERS AND LVDP
Mitral flow Doppler Mitral flow Doppler alone is not enough!alone is not enough!
LV DIASTOLIC FUNCTION
E/e’ and LV filling pressure l April 21, 2023 l 10
MITRAL ANNULAR VELOCITY
LV relaxation kinetics
e’ wave
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WHAT IS e’?
•It behaves as an index of LV relaxation
•Significant inverse correlation with tau
•No change with preload alterations
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LV relaxation kinetics
LA pressure
LV relaxation kinetics
E
e’
WHY E/e’?
E/e’ and LV filling pressure l April 21, 2023 l 14
LV relaxation kinetics
LA pressure
LV relaxation kinetics
WHY E/e’?
E
e’
E/e’ and LV filling pressure l April 21, 2023 l 15
Presentation Title l April 21, 2023 l 16
Masutani et al. Circulation 2008;117:1550-1554.
RESTRICTIVE LV FILLING
DIASTOLIC MITRAL ANNULAR VELOCITY
Hasegawa et al. J Am Coll Cardiol 2003;41;1590-7.
E/e’ and LV filling pressure l April 21, 2023 l 18
NormalNormal
HF
HF
DIASTOLIC PARAMETERS AND TAU ()
Hasegawa et al. J Am Coll Cardiol 2003;41;1590-7.
E/e’ and LV filling pressure l April 21, 2023 l 19
E (
ml/s
ec)
Pea
k e’
(m
m/s
ec)
•What is E/e’
•Determination of LV filling pressure
•Evaluation of pts with HF
E/e’ and LV filling pressure l April 21, 2023 l 20
TO THE POINT
ASSESSMENT OF LV FILLING PRESSURE
Ommen et al. Circulation 2000;102:1788-1794.
E/e’ and LV filling pressure l April 21, 2023 l 21
LV FILLING PRESSURE DEFINED BY E/e’
Ommen et al. Circulation 2000;102:1788-1794.
E/e’ and LV filling pressure l April 21, 2023 l 22
EF <50%
EF >50%
E/e’ <8 E/e’ >15
LV
DP
(m
mH
g)
LV FILLING PRESSURE DEFINED BY E/e’
Ommen et al. Circulation 2000;102:1788-1794.
E/e’ and LV filling pressure l April 21, 2023 l 23
LV
DP
(m
mH
g)
E/e’ 8÷15
EF <50%
EF >50%
E/e’ and LV filling pressure l April 21, 2023 l 24
Ommen et al. Circulation 2000;102:1788-1794.
LV FILLING PRESSURE DEFINED BY E/e’
X XX X
PVa-Mva >30 ms
Valsalva +ve
Flow Doppler -ve
>1 variable +ve X
E/e’ 8÷15
LV
DP
(m
mH
g)
E/e’ and LV filling pressure l April 21, 2023 l 25
Ommen et al. Circulation 2000;102:1788-1794.
LV FILLING PRESSURE DEFINED BY E/e’
X XX X
PVa-Mva >30 ms
Valsalva +ve
>1 variable +ve X
E/e’ 8÷15
LV
DP
(m
mH
g)
E/e’ and LV filling pressure l April 21, 2023 l 26
Ommen et al. Circulation 2000;102:1788-1794.
LV FILLING PRESSURE DEFINED BY E/e’
X X
Flow Doppler -ve
E/e’ 8÷15
LV
DP
(m
mH
g)
ONE SIZE FITS ALL!
E/e’ and LV filling pressure l April 21, 2023 l 27
CONSTRICTIVE PERICARDITIS
Ha et al. Circulation 2001;104:976-978.
PCWP 31 mmHgE/e’ 5
PCWP 18 mmHgE/e’ 17
E/e’ and LV filling pressure l April 21, 2023 l 29
•What is E/e’
•Determination of LV filling pressure
•Evaluation of pts with HF
E/e’ and LV filling pressure l April 21, 2023 l 30
TO THE POINT
E/e’ and LV filling pressure l April 21, 2023 l 33
E/e’
E/e’ ≤8(sept, lat, or average)
Sept E/e’ ≥15or
Lat E/e’ ≥12or
Aver E/e’ ≥13
Estimation of filling pressures in patients with normal EF
LAP
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
LAP
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Normal LAP
Normal LAP
Estimation of filling pressures in patients with normal EF
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E vel = 82 cm/sec e’ vel = 4 cm/sec
E/e’ = 82/4 = 20.5
E/e’
E/e’ ≤8(sept, lat, or average)
Sept E/e’ ≥15or
Lat E/e’ ≥12or
Aver E/e’ ≥13
Estimation of filling pressures in patients with normal EF
LAP
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
LAP
E/e’ and LV filling pressure l April 21, 2023 l 37
Normal LAP
Normal LAP
E/e’
E/e’ ≤8(sept, lat, or average)
Sept E/e’ ≥15or
Lat E/e’ ≥12or
Aver E/e’ ≥13
Estimation of filling pressures in patients with normal EF
LAP
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
LAP
E/e’ and LV filling pressure l April 21, 2023 l 38
Normal LAP
Normal LAP
E/e’
E/e’ ≤8(sept, lat, or average)
Sept E/e’ ≥15or
Lat E/e’ ≥12or
Aver E/e’ ≥13
Estimation of filling pressures in patients with normal EF
LAP
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
LAP
E/e’ and LV filling pressure l April 21, 2023 l 39
Normal LAP
Normal LAP
E/e’
E/e’ ≤8(sept, lat, or average)
Sept E/e’ ≥15or
Lat E/e’ ≥12or
Aver E/e’ ≥13
Estimation of filling pressures in patients with normal EF
LAP
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
LAP
E/e’ and LV filling pressure l April 21, 2023 l 40
Normal LAP
Normal LAP
Mitral E/A
E/A <1 and
E ≤50 cm/secE/A ’ ≥2,
DT <150 ms
Estimation of filling pressures in patients with depressed EF
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’ and LV filling pressure l April 21, 2023 l 41
Normal LAP
Normal LAP
LAP LAP
E/e’
E/e’ and LV filling pressure l April 21, 2023 l 42
E/e’ and LV filling pressure l April 21, 2023 l 43
VIZI PRIVATI, PUBBLICHE VIRTU’
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E/e’ and LV filling pressure l April 21, 2023 l 47
SI FA, MA NON SI DICE …
Dini FL et al. Eur J Echocardiogr 2010;11;703-710.
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Presentation Title l April 21, 2023 l 50
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 SalustriContro: Maurizio Galderisi
Moderatori:
Alfredo Zuppiroli
Maurizio Galderisi
E/e’ and LV filling pressure l April 21, 2023 l 51
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Presentation Title l April 21, 2023 l 53