M-mode, Basic Measurements, Doppler Basics and TDI

What is located on the x-axis and y-axis in m-mode?

1. X = Time

2. Y = Distance

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PLAX image showing LA and AV

1. RV

2. Aortic root

3. AV leaflets opening

4. LA

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PLAX image showing LA and AV

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PLAX or PSAX image showing MV

1. IVS

2. RV

3. LVOT

4. Anterior MV leaflet

5. Posterior MV leaflet

6. Posterior wall

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PLAX or PSAX image showing MV

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PLAX or PSAX image showing LV

1. LV end systolic dimension

2. IVS

3. LV end diastolic dimension

4. LV posterior wall

5. Chordae

6. RV

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PLAX or PSAX image showing LV

How do you measure the LVOT?

1. PLAX

2. Mid systole

3. Inner to inner

How do you measure the aortic root, STJ, and ascending aorta?

1. PLAX

2. End-diastole (before AV opens)

3. Leading edge to leading edge

How do you measure the LV size or Linear Meas in end-diastole?

1. PLAX

2. End-diastole

3. LARGEST LV diameter

How do you measure the LV size or Linear Meas in systole?

1. PLAX

2. End-systole

3. SMALLEST LV diameter

How do you measure LA diameter?

1. PLAX

2. End-systole

3. Inner to inner with caliper line perpendicular to LA posterior wall

What is the normal value for LA diameter?

1. Men: < 4 cm

2. Women: < 3.8 cm

How do you measure LA volume?

1. A4C and A2C

2. End-systole

3. Calipers placed inner to inner on each MV annulus border

What structures should be excluded from a LA volume measurement?

1. MV annulus

2. PVs

3. LAA

What is the normal value for LA volume index?

< 34 ml/m²

How do you measure LV volume and LVEF?

A4C and A2C using modified Simpson’s

What is the formula for LVEF?

LVEF = LVEDV - LVESV / LVEDV

What is the normal range for LVEF?

1. Men: 52 - 72%

2. Women: 54-74%

What is the formula for fractional shortening (FS)?

FS = (LVd - LVs / LVd) x 100

What is the normal value for fractional shortening (FS)?

FS > 25%

How do you measure RV size?

1. A4C

2. End-diastole

3. Width at basal and mid level

4. Length from annulus to apex

What is TAPSE?

Measurement performed to determine RV systolic function

What is the normal value for TAPSE?

> 17 mm

What is RV TDI?

Measurement that determines how fast basal RV free wall moves during systole

What is the normal value for RV TDI?

S’ > 9.5 cm/sec

What is RIMP?

Measurement of global RV performance

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RIMP

• IVCT

• IVRT

• ET or ejection time

• TCO or TV closure opening time

How do you measure RA volume?

1. A4C

2. End-systole

3. Calipers placed inner to inner on each TV annulus border

What is the normal value for RA volume?

1. Men: < 32 L/m²

2. Women: < 27 mL/m²

How do you measure the IVC?

Subcostal long

Which measurement is used to calculate RA pressure?

Measuring IVC

What are the normal ranges for RA pressure?

1. 3 mmHg (normal) = IVC diameter < 2.1 that collapses > 50% w/ sniff

2. 15 mmHg (high) = IVC diameter > 2.1 that collapses < 50% w/ sniff

3. 8 mmHg = IVC diameter and collapse do not fit other options

What is RVSP?

Measurement of pulmonary artery systolic pressure

What is the formula for RVSP?

RVSP = 4v² + RAP

How do you calculate velocity time integral (VTI)?

Trace flow profile

What measurements does the flow profile provide?

1. VTI

2. Peak velocity

3. Mean velocity

4. Peak pressure gradient

5. Mean pressure gradient

What is acceleration time?

Time from onset of flow to peak velocity

What is deceleration time?

Time from peak flow to end of flow

What is pressure half time (PHT)?

Time it takes for peak pressure to drop to half its original value

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Normal MV inflow

1. E-wave or diastolic filling

2. A-wave or atrial kick

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IVRT

• IVCT

• IVRT

• FT

• ET or ejection time

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Normal PV inflow

1. S-wave or PSV

2. D-wave or PDV

3. A-wave or peak atrial reversal velocity

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Normal hepatic vein flow

1. S-wave or PSV

2. D-wave or PDV

3. A-wave or peak atrial reversal velocity