Echocardiographic examination

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TECHmED.sk

New examination
Left ventricle
LV diastolic function
Right ventricle
RV pressure
Kinetics and effusion
Atria and IVC
Aorta
AV
MV
TV
PV
Summary
Values
Views

Echocardiographic examination

TECHmED.sk

New
LV
LV diastole
RV
RV pressure
Kinetics
Atria
Aorta
AV
MV
TV
PV
Summary
Values
Views

Mitral valve

Mitral valve Va (Aliasing velocity) Apical 4 chamber (A4C) focused left atrium

Va

Aliasing velocity

VCW (Vena contracta width) Apical 4 chamber (A4C) focused left atrium

VCW

Vena contracta width

Mitral valve PISAr (Proximal isovelocity surface area radius) Apical 4 chamber (A4C) focused left atrium

PISAr

Proximal isovelocity surface area radius

Mitral valve Vmax MR (Peak velocity mitral regurgitation) A4C (apical 4 chamber view) CW doppler of mitral valve

Vmax MR

Peak velocity mitral regurgitation

Mitral valve Va and PISAr (Aliasing velocity, Proximal isovelocity surface area radius) Mitral valve Vmax MR (Peak velocity mitral regurgitation) Mitral valve EROA (Effective Regurgitant Orifice Area)

EROA

Effective Regurgitant Orifice Area

Dominant mitral A wave (A wave > E wave) Apical 4 chamber (A4C). Mitral valve PW doppler

A wavedominant

Dominant mitral A wave (A wave > E wave)

RegJet soft density (Regurgitant jet soft density) A4C (apical 4 chamber view) CW doppler of mitral valve

RegJetsoft density

Regurgitant jet soft density

RegJet area (Regurgitation jet area) Apical 4 chamber (A4C) focused left atrium

RegJetarea

Regurgitation jet area

LA area (Left atrial area) Apical 4 chamber (A4C) focused left atrium

LA area

Left atrial area

RegJet area (Regurgitation jet area) LA area (Left atrial area)

RegJet/LA area

Ratio RegJetarea/LA area

PV reversal flow (Pulmonary vein systolic flow reversal) A4C (Apical 4 chamber view) LA pulmonary veins focus, systole, PW doppler

PVreversal flow

Pulmonary vein systolic flow reversal

LVOT diameter (Left ventricular outflow tract diameter) LVOT VTI (Velocity time integral of left ventricular outflow tract)

SVAoV

Stroke volume of aortic valve

MV diameter (Mitral valve diameter) A4C (apical 4 chamber view)

MVdiameter

Mitral valve diameter

VTI MV (Velocity time integral mitral valve inflow) PW doppler Apical 4 chamber (A4C). Mitral valve PW doppler

VTI MV

Velocity time integral mitral valve inflow

MV diameter (Mitral valve diameter) VTI MV (Velocity time integral mitral valve inflow) PW doppler

SVMV

Stroke volume of mitral valve

MV diameter (Mitral valve diameter) VTI MV (Velocity time integral mitral valve inflow) PW doppler
LVOT VTI (Velocity time integral of left ventricular outflow tract) PW doppler LVOT diameter (Left ventricular outflow tract diameter)

RegVolMV

Regurgitant volume of mitral regurgitation

MV diameter (Mitral valve diameter) VTI MV (Velocity time integral mitral valve inflow) PW doppler
LVOT VTI (Velocity time integral of left ventricular outflow tract) PW doppler LVOT diameter (Left ventricular outflow tract diameter)

RFMV

Regurgitant fraction of mitral valve

LVEDV (Left ventricular end-diastole volume) LVESV (Left ventricular end-systole volume)

LV EF

Left ventricular ejection fraction (Biplane Method of Discs)

LA volume (Left atrial volume - Biplane) Apical 4 chamber (A4C) focused left atrium

LA volume

Left atrial volume (Biplane)

LVEDV (Left ventricular end-diastole volume) Apical 4 Chamber View (A4C) zoomed left ventricle

LVEDV

Left ventricular end-diastole volume

MVA (Mitral valve area) PSAX (parasternal short axis) level of MV (mitral valve)

MVA

Mitral valve area

meanPG MV (Mitral valve mean pressure gradient) A4C (apical 4 chamber view) CW doppler of mitral stenosis

meanPG MV

Mitral valve mean pressure gradient

Vmax TR (Peak tricuspid regurgitation systolic jet velocity) CW doppler RAP (Right atrial pressure), IVC, IVC sniff

RVSP(SPAP)

Right ventricular systolic pressure

References:

Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the ASE and EACVI (2015)

Recommendations for the Evaluation of LV Diastolic Function by Echocardiography: An Update from the ASE and EACVI (2016)

Recommendations on the use of echocardiography in adult hypertension: a report from the EACVI and the ASE (2015)

Recommendations on the Echocardiographic Assessment of Aortic Valve Stenosis: A Focused Update from the EACVI and the ASE (2017)

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

Guidelines for the Echocardiographic Assessment of the Right Heart in Adults: ASE, EACVI, ESC, CSE (2010)

Guidelines for the diagnosis and management of acute pulmonary embolism ESC, ERS (2019)

Echocardiography in aortic diseases: EAE recommendations for clinical practice (2010)

Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice (2009)

ESSENTIAL ECHOCARDIOGRAPHY A Companion to Braunwald’s Heart Disease

Coronary Artery Territories (Echocardiography Illustrated Book 4)

Regurgitation

Va
cm/s

Aliasing velocity

VCW
cm

Vena contracta width

PISAr
cm

Proximal isovelocity surface area radius

Vmax MR
m/s

Peak velocity mitral regurgitation

EROA
cm2

Effective regurgitant orifice area
EROA = 2π x PISAr2 x Va / Vmax MR

A wavedominant

Dominant mitral A wave (A wave > E wave)

RegJetsoft density

Regurgitant jet soft density

RegJetarea
cm2

Regurgitation jet area

LA area
cm2

Left atrial area

RegJet/LA area
%

Ratio RegJetarea / LA area
RegJet/LA area = RegJetarea/LA area x 100

PVreversal flow

Pulmonary vein systolic flow reversal

Volume

SVAoV
ml

Stroke volume of aortic valve
SVAoV = CSALVOT x VTILVOT

MVdiameter
cm

Mitral valve diameter
CSAMV = π(MVdiameter/2)2

VTI MV
cm

Velocity time integral mitral valve inflow

SVMV
ml

Stroke volume of mitral valve
SVMV = CSAMV x VTI MV

RegVolMV
ml

Regurgitant volume of mitral regurgitation
RegVolMV = SVMV - SVAoV

RFMV
%

Regurgitant fraction of mitral valve
RFMV = RegVolMV / SVMV x 100

LV EF
%

Left ventricular ejection fraction (Biplane)
LV EF = (LVEDV - LVESV) / LVEDV x 100

LA volume
ml/m2

Left atrial volume (Biplane)

LVEDV
ml

Left ventricular end-diastole volume

Stenosis

MVA
cm2

Mitral valve area

meanPG MV
mmHg

Mitral valve mean pressure gradient

RVSP(SPAP)
mmHg

Right ventricular systolic pressure
RVSP = 4 x Vmax TR2 + RAP

Mitral valve Va (Aliasing velocity) Apical 4 chamber (A4C) focused left atrium

Va

Aliasing velocity

  • Manually set value on the echocardiography machine.
  • It´s used to calculate: EROA.
  • Nyquist limit: 50-70cm/s
    • Baseline is shifted in the direction of mitral regurgitation jet to 30-40cm/s.
    • Aliasing occurs: If the blood flow from the probe (blue) exceeds the Va speed (38.5cm/s).