AMA Category 1 Credit for Physicians Only.
ASRT CME is not available.
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The TEE showed:
The LVEF is 40%. The apex is HK. The mid Anteroseptal wall is AK.
Parametric showed anterior, anteroseptal, some septal AK
LVEDD 5.19 cm, LVESD 3.70 cm
The RVEF is 50%.
LVI: The E is 83 cm/sec, DT 246 msec, IVRT 95 msec,A 44 cm/sec, Adur(158 msec), E/A = 1
TDE: The S` is 5.8 cm/sec, E` 9.1 cm/sec, A` 14.9 cm/sec
PVn: The S is 53 cm/sec, D 44 cm/sec, A 20 cm/sec (Adur 116 msec)
The CMMVp is 35.3 cm/sec.
The Desc Ao Grade 3, AscAo Grade 2 by TEE, Grade 4 by EA
AV Vmax 1.16 m/sec, pAVG 5 mmHg, mAVG 2 mmHg. AVA by 2D TEE 2.7 cm2.
TR Vmax 2 m/sec
Lambl's Excressence was present.
A moderator band was present.
The PCWP by Adur/Adur is 10 mmHg. The PCWP by DT is < 10 mmHg.
The CPCWP by TDE E/LVI Emax = 14.9 mmHg.
The LAP by Emax/Vp = 16.9 mmHg.
Parametric imaging, which is the conversion of a 3D loop to a still frame showing the
initiation(timing) of wall excursion and the amount/direction of wall excursion, can impact
the interpretation of a TEE. Toledo, Angelini, and others showed that parametric imaging of the
left ventricle is accurate with an acceptable senstivity and specificity rate.
Kachenoura showed that the time to first contraction
are delayed in hypokinetic (150 msec) and akinetic (200 msec) segments more than normal (100 msec) segments.
The mean contraction time showed the same delay pattern. The radial velocity was also lowered for
akinetic (1 cm/sec) segements and hypokinetic (2 cm/sec) more than normal segements (3 cm/sec).
Caiani showed that inexperienced echocardiographers improved
their accuracy more but did not become more accurate than experience echocardiographers when
parametric images were added to the exam (animal study). Kachenoura showed that in patients
with poor acoustic windows, using parametric images along with contrast, improved the
accuracy of RWMA diagnosis in inexperienced users.
Myocardial dyssynchrony can be difficult to appreciate when the delay is less than 80 msec.
Parametric imaging shows an image of the onset of contraction for segments where the amount of
delay is easier to visualize and will even point out the segments that are delayed and the degree
of the delay. While the posterolateral wall is the usually wall that is delayed in a wide QRS and decreased
LVEF, O'Mara showed that this is not always the case and segments or the delay of segmental contraction can
be delayed or improperly treated with a biventricular pacer with improper lead placement. Also, if multiple segments
are delayed, the parametric image will help decipher where to place the leads to achieve maximum benefit.
|Please answer the following questions correctly to obtain your CME.|
Improvement in echocardiographic evaluation of left ventricular wall motion using still-frame parametric imaging.
Diagnostic value of parametric imaging of left ventricular wall motion from contrast-enhanced echocardiograms in patients with poor acoustic windows.
Evaluation of Regional Myocardial Function Using Automated Wall Motion Analysis of Cine MR Images: Contribution of Parametric Images, Contraction Times, and Radial Velocities
Regional patterns of dyssynchrony: lateral wall delay is desirable but not essential for left ventricular remodeling in biventricular pacing.
Assessment of left ventricular contraction by parametric analysis of main motion (PAMM): theory and application for echocardiography.
Segmentation of real-time three-dimensional ultrasound for quantification of ventricular function: a clinical study on right and left ventricles.
Quantitative diagnosis of stress-induced myocardial ischemia using analysis of contrast echocardiographic parametric perfusion images.