Normal E/e' ratio in patient with restrictive MV inflow pattern suggests
Constriction
Normal E/e'
Septal: 8 or less
Lateral: 12 or less
Normal LAP
<12 mmHg
Normal RA pressure
0-5 mmHg
Normal PAP
20-30 mmHg
PAWP calc by echo (Vp)
PAWP = 4.6 + 5.27 x E/Vp
Normal Vp(prop vel) =
> 55 cm/ sec ( young)
> 45 cm/ sec middle age+
PVR calc by ECHO
PVR = (mean PAP - mean LAP) / Qp
LVEDP calc using ARedv
LVEDP=DBP - 4 x (ARedv)2
LAP calc with MR velocity
LAP = SBP - 4 x (Vmr)2
Valid only if no sig AS/lvot grad
Estimated LA pressure with E/e'
4 + E/e'
LV SBP
4 x (Vmr)2 + LAP
Calc RVSP
TR
VSD
PDA
TR + RA
SBP - VSD
SBP - PDA
Calc PA edp
EDpa + RA
Mean PA pressure
PR
PA accel
4*(peak Vpr)2
RVOT Acceleration time
79 - (0.45 x Accel t)
80 - (0.50 x accel t)
HR must be between 60-80.
Not valid with asd or vsd
peak diastolic PR gradient
RVedp by VSD
LVedp - EDvsd
Calc LAP with MS without MR
LAP=Mean mitral gradient in diastole+Early LV diastolic pressure
Usually PASP = RVSP, but in PS RVSP > PASP. Calc PASP.
PASP = RVSP - PV peak grad
e' < 5 cm/sec indicates
Severe diastolic dysfxn
Septal e' >8 indicates
Lateral e' >10
LAVI <34
normal EF
Normal diastolic fxn
PVR woods units
Qp calc
TR velocity
PVR= MPP−LAP / Qp(l/min)
MPP={[2*PADP+PASP]/3}/ Qp
PVR = 10(V tr / VTI rvot)
Normal PVR (woods unit)
Precludes closure ASD
1-2 woods unit
>9 woods units
SVR normal (woods unit)
13 (11-16) woods unit
E/e' indices indicating Increased LA Filling pressure in normal EF
Septal E/e' >15
Lateral E/e' >12
Average E/e' >13
E/e' <8 indicates
Normal LA filling pressure
E/A >2, DT<150 in depressed EF Indicates
Increased LAP
E/A <1 and E <0.5 in depressed EF indicates
Normal LAP
Indeterminant mitral E/A with depressed EF.
Normal LAP findings:
E/e
E/Vp
S/D
Ar-A
Val E/A
PAP
IVRT/Te
E/e'<8
E/Vp<1.4
S/D>1
Ar-A<0
Val E/A<0.5
PAP<30
IVRT/Te>2
Findings for Increased LAP with depressed EF and indeterminant E/e'
E/e'
E/Vp
S/D
Ar-A
Val E/A
PAP
IVRT/Te
E/e'>15
E/Vp>2.5
S/D<1
Ar-A>30
Val E/A>0.5
PAP>35
IVRT/Te<2
Calculate mean PAP pressures
mean PAP = (PAP Systolic + 2*PAP Diastolic)/3
Calculate MAP pressures
mean SAP = (SAP Systolic + 2*SAP Diastolic)/3
Calculate SVR continuity
SVR = (meanSAP-meanRAP)*80/CardiacOutput
Calculate PVR continuity
PVR = (meanPAP - Wedge Pressure)*80/CardiacOutput
Expected mitral inflow >50 years old
E>A
Grade1
Calculate PAD by PDA
DBP-4*(EDVpda)2
What is PA systolic pressure of patient with peak TR velocity of 4m/s with estimated RA pressure 10 mmHg and pulmonic stenosis with PV gradient 3m/s.
38 mmHg
RAP Estimation Using IVC Collapse Index and Hepatic Venous Flow
Mean RAP
*IVC% Collapse
*Hepatic Veins
0–5 mm Hg
≥50%
Vs > VD
5–10 mm Hg
≥50%
Vs = VD
10–15 mm Hg
<50%
Vs < VD
≥20 mm Hg
<50%
Flow only with VD
JVP 15cm H2O correlates RA pressure of ?
jugular venous pressure of 15 cm water corresponds to 15 × 0.7 or 10–11 mm Hg, since 1 cm water corresponds to 0.7 mm Hg
Estimate of PVR noninvasively by doppler
* PVR = 10(V tr / VTI rvot)
estimated noninvasively by using the ratio between peak velocity of TR jet (as a surrogate of PA pressure), and time velocity integral of RVOT systolic flow (as a surrogate of cardiac output)