alessandro salustri cardiology consultant head noninvasive laboratory
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 Salustri Cardiology Consultant Head Noninvasive Laboratory - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory](https://reader035.vdocuments.us/reader035/viewer/2022081519/56814336550346895dafaa2d/html5/thumbnails/1.jpg)
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.
![Page 2: Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory](https://reader035.vdocuments.us/reader035/viewer/2022081519/56814336550346895dafaa2d/html5/thumbnails/2.jpg)
•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
![Page 3: Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory](https://reader035.vdocuments.us/reader035/viewer/2022081519/56814336550346895dafaa2d/html5/thumbnails/3.jpg)
LV relaxation kinetics
LA pressure
MITRAL INFLOW VELOCITY
E wave
E/e’ and LV filling pressure l April 21, 2023 l 3
![Page 4: Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory](https://reader035.vdocuments.us/reader035/viewer/2022081519/56814336550346895dafaa2d/html5/thumbnails/4.jpg)
PHYSIOLOGY OF LV FILLING
Little and Oh. Circulation 2009;120:802-809.
E/e’ and LV filling pressure l April 21, 2023 l 4
![Page 5: Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory](https://reader035.vdocuments.us/reader035/viewer/2022081519/56814336550346895dafaa2d/html5/thumbnails/5.jpg)
Presentation Title l April 21, 2023 l 5
RESTRICTIVE LV FILLING
Masutani et al. Circulation 2008;117:1550-1554.
![Page 6: Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory](https://reader035.vdocuments.us/reader035/viewer/2022081519/56814336550346895dafaa2d/html5/thumbnails/6.jpg)
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
![Page 7: Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory](https://reader035.vdocuments.us/reader035/viewer/2022081519/56814336550346895dafaa2d/html5/thumbnails/7.jpg)
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
![Page 8: Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory](https://reader035.vdocuments.us/reader035/viewer/2022081519/56814336550346895dafaa2d/html5/thumbnails/8.jpg)
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
![Page 9: Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory](https://reader035.vdocuments.us/reader035/viewer/2022081519/56814336550346895dafaa2d/html5/thumbnails/9.jpg)
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
![Page 10: Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory](https://reader035.vdocuments.us/reader035/viewer/2022081519/56814336550346895dafaa2d/html5/thumbnails/10.jpg)
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
![Page 11: Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory](https://reader035.vdocuments.us/reader035/viewer/2022081519/56814336550346895dafaa2d/html5/thumbnails/11.jpg)
MITRAL ANNULAR VELOCITY
LV relaxation kinetics
e’ wave
E/e’ and LV filling pressure l April 21, 2023 l 11
![Page 12: Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory](https://reader035.vdocuments.us/reader035/viewer/2022081519/56814336550346895dafaa2d/html5/thumbnails/12.jpg)
WHAT IS e’?
•It behaves as an index of LV relaxation
•Significant inverse correlation with tau
•No change with preload alterations
E/e’ and LV filling pressure l April 21, 2023 l 12
![Page 13: Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory](https://reader035.vdocuments.us/reader035/viewer/2022081519/56814336550346895dafaa2d/html5/thumbnails/13.jpg)
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
![Page 14: Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory](https://reader035.vdocuments.us/reader035/viewer/2022081519/56814336550346895dafaa2d/html5/thumbnails/14.jpg)
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
![Page 15: Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory](https://reader035.vdocuments.us/reader035/viewer/2022081519/56814336550346895dafaa2d/html5/thumbnails/15.jpg)
Presentation Title l April 21, 2023 l 16
Masutani et al. Circulation 2008;117:1550-1554.
RESTRICTIVE LV FILLING
![Page 16: Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory](https://reader035.vdocuments.us/reader035/viewer/2022081519/56814336550346895dafaa2d/html5/thumbnails/16.jpg)
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
![Page 17: Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory](https://reader035.vdocuments.us/reader035/viewer/2022081519/56814336550346895dafaa2d/html5/thumbnails/17.jpg)
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)
![Page 18: Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory](https://reader035.vdocuments.us/reader035/viewer/2022081519/56814336550346895dafaa2d/html5/thumbnails/18.jpg)
•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
![Page 19: Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory](https://reader035.vdocuments.us/reader035/viewer/2022081519/56814336550346895dafaa2d/html5/thumbnails/19.jpg)
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
![Page 20: Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory](https://reader035.vdocuments.us/reader035/viewer/2022081519/56814336550346895dafaa2d/html5/thumbnails/20.jpg)
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)
![Page 21: Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory](https://reader035.vdocuments.us/reader035/viewer/2022081519/56814336550346895dafaa2d/html5/thumbnails/21.jpg)
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%
![Page 22: Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory](https://reader035.vdocuments.us/reader035/viewer/2022081519/56814336550346895dafaa2d/html5/thumbnails/22.jpg)
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)
![Page 23: Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory](https://reader035.vdocuments.us/reader035/viewer/2022081519/56814336550346895dafaa2d/html5/thumbnails/23.jpg)
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)
![Page 24: Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory](https://reader035.vdocuments.us/reader035/viewer/2022081519/56814336550346895dafaa2d/html5/thumbnails/24.jpg)
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)
![Page 25: Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory](https://reader035.vdocuments.us/reader035/viewer/2022081519/56814336550346895dafaa2d/html5/thumbnails/25.jpg)
ONE SIZE FITS ALL!
E/e’ and LV filling pressure l April 21, 2023 l 27
![Page 26: Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory](https://reader035.vdocuments.us/reader035/viewer/2022081519/56814336550346895dafaa2d/html5/thumbnails/26.jpg)
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
![Page 27: Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory](https://reader035.vdocuments.us/reader035/viewer/2022081519/56814336550346895dafaa2d/html5/thumbnails/27.jpg)
•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
![Page 28: Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory](https://reader035.vdocuments.us/reader035/viewer/2022081519/56814336550346895dafaa2d/html5/thumbnails/28.jpg)
E/e’ and LV filling pressure l April 21, 2023 l 33
![Page 29: Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory](https://reader035.vdocuments.us/reader035/viewer/2022081519/56814336550346895dafaa2d/html5/thumbnails/29.jpg)
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 34
Normal LAP
Normal LAP
![Page 30: Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory](https://reader035.vdocuments.us/reader035/viewer/2022081519/56814336550346895dafaa2d/html5/thumbnails/30.jpg)
Estimation of filling pressures in patients with normal EF
E/e’ and LV filling pressure l April 21, 2023 l 35
![Page 31: Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory](https://reader035.vdocuments.us/reader035/viewer/2022081519/56814336550346895dafaa2d/html5/thumbnails/31.jpg)
E/e’ and LV filling pressure l April 21, 2023 l 36
E vel = 82 cm/sec e’ vel = 4 cm/sec
E/e’ = 82/4 = 20.5
![Page 32: Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory](https://reader035.vdocuments.us/reader035/viewer/2022081519/56814336550346895dafaa2d/html5/thumbnails/32.jpg)
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
![Page 33: Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory](https://reader035.vdocuments.us/reader035/viewer/2022081519/56814336550346895dafaa2d/html5/thumbnails/33.jpg)
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
![Page 34: Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory](https://reader035.vdocuments.us/reader035/viewer/2022081519/56814336550346895dafaa2d/html5/thumbnails/34.jpg)
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
![Page 35: Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory](https://reader035.vdocuments.us/reader035/viewer/2022081519/56814336550346895dafaa2d/html5/thumbnails/35.jpg)
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
![Page 36: Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory](https://reader035.vdocuments.us/reader035/viewer/2022081519/56814336550346895dafaa2d/html5/thumbnails/36.jpg)
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’
![Page 37: Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory](https://reader035.vdocuments.us/reader035/viewer/2022081519/56814336550346895dafaa2d/html5/thumbnails/37.jpg)
E/e’ and LV filling pressure l April 21, 2023 l 42
![Page 38: Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory](https://reader035.vdocuments.us/reader035/viewer/2022081519/56814336550346895dafaa2d/html5/thumbnails/38.jpg)
E/e’ and LV filling pressure l April 21, 2023 l 43
![Page 39: Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory](https://reader035.vdocuments.us/reader035/viewer/2022081519/56814336550346895dafaa2d/html5/thumbnails/39.jpg)
VIZI PRIVATI, PUBBLICHE VIRTU’
E/e’ and LV filling pressure l April 21, 2023 l 44
![Page 40: Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory](https://reader035.vdocuments.us/reader035/viewer/2022081519/56814336550346895dafaa2d/html5/thumbnails/40.jpg)
E/e’ and LV filling pressure l April 21, 2023 l 45
![Page 41: Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory](https://reader035.vdocuments.us/reader035/viewer/2022081519/56814336550346895dafaa2d/html5/thumbnails/41.jpg)
E/e’ and LV filling pressure l April 21, 2023 l 46
![Page 42: Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory](https://reader035.vdocuments.us/reader035/viewer/2022081519/56814336550346895dafaa2d/html5/thumbnails/42.jpg)
E/e’ and LV filling pressure l April 21, 2023 l 47
![Page 43: Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory](https://reader035.vdocuments.us/reader035/viewer/2022081519/56814336550346895dafaa2d/html5/thumbnails/43.jpg)
SI FA, MA NON SI DICE …
Dini FL et al. Eur J Echocardiogr 2010;11;703-710.
E/e’ and LV filling pressure l April 21, 2023 l 48
![Page 44: Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory](https://reader035.vdocuments.us/reader035/viewer/2022081519/56814336550346895dafaa2d/html5/thumbnails/44.jpg)
E/e’ and LV filling pressure l April 21, 2023 l 49
![Page 45: Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory](https://reader035.vdocuments.us/reader035/viewer/2022081519/56814336550346895dafaa2d/html5/thumbnails/45.jpg)
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
![Page 46: Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory](https://reader035.vdocuments.us/reader035/viewer/2022081519/56814336550346895dafaa2d/html5/thumbnails/46.jpg)
E/e’ and LV filling pressure l April 21, 2023 l 51
![Page 47: Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory](https://reader035.vdocuments.us/reader035/viewer/2022081519/56814336550346895dafaa2d/html5/thumbnails/47.jpg)
E/e’ and LV filling pressure l April 21, 2023 l 52
![Page 48: Alessandro Salustri Cardiology Consultant Head Noninvasive Laboratory](https://reader035.vdocuments.us/reader035/viewer/2022081519/56814336550346895dafaa2d/html5/thumbnails/48.jpg)
Presentation Title l April 21, 2023 l 53