Valvular Disease
Pericardial Disease
Myocardial Disease
Congenital Disease
Miscellanous
Evaluation of Left Ventricular Function
M-Mode
- Evaluate wall contractility (wall thickness, systolic wall thickening, systolic wall motion)
- B -"bump" or "notch" of mitral valve indicates increased LVEDP ≥15 mm Hg
- B "bump" or "notch" tricuspid valve indicates increased RVEDP ≥9 mm Hg
- Mitral valve E-point to septal separation > 20 mm indicates an ejection fraction of < 30%
- Premature closure of the mitral valve (when the C point of the mitral valve occurs on or before the onset of the QRS complex)
- Premature opening of the aortic valve (when the aortic valve opens on or before the onset of the QRS complex)
M-mode parameters
- Ventricular end-diastolic dimension :
37 to 56 mm
- Ventricular end-systolic dimension :
26 to 36 mm
- Left ventricular diastolic IVS thickness :
7 to 11 mm
- IVS excursion :
6 to 11 mm
- IVS % thickening :
27 to 70%
- Left ventricular posterior diastolic wall thickness :
7 to 11 mm
- LVPW excursion :
9 to 14 mm
- LVPW% thickening :
25 to 80%
- Percent fractional shortening :
28 to 41%
- Ejection fraction :
48 to 78%
- PEP/LVET :< 0.42
- Mean Vcf :
1.0 to 1.9 Vcf
- Stroke volume :
75 to 100 cc
- Cardiac output :
4 to 8 L/min
- Cardiac index :
2. 4 to 4. 2 L/min/m2
- Left ventricular mass : ≤ 294 gm in men, ≤ 198 gm in women
- Left ventricular mass index : < 134 gm m2 in men, < 110 gm m2 in women
- Mitral valve E-F slope :
70 to 150 mm/sec
- Mitral valve E-point septal separation : ≤ 7 mm
2-D
- Determine left ventricular function with qualitative visualization of left ventricular function
- Determine segmental wall motion abnormalities
- Determine ejection fraction (Simpson's disc or area-length method)
- Determine fractional area change (normal range: 36 to 64%)
- Determine the descent of the base (≥ 10 mm predicts a normal ejection fraction)
Doppler
- Evaluate aortic flow velocity tracing
- Determine flow velocity integral
- Determine stroke-volume
- Determine cardiac output
- Determine change in pressure over time (dP/dt)
Left Ventricular Function Doppler Parameters
- Flow velocity integral
- Normal aortic valve: 18 to 22 cm
- Normal mitral valve: 10 to 13 cm
- Dp/dt
- Normal >1200 mmHg/sec
- Borderline 1000 to 1200 mmHg/sec
- Abnormal <1000 mmHg/sec
Left ventricular function (aortic flow velocity tracing)
- Peak flow velocity :
72 to 120 (mean
92)
- Acceleration time (msec) :
83 to 118 (
98 )
- Average acceleration (cm/sec) :
735 to 1318 (
955 )
- Deceleration time (msec) :
170 to 230 (
197 )
- Average deceleration (cm/sec2) :
355 to 630 (
473 )
- Ejection time (msec) :
255 to 325 (
294 )
Echocardiography Books