Restrictive cardiomyopathy is characterized by
1) abrupt cessation of diastolic filling in the first 1/3rd of diastole
2) Associated with large atria, normal-sized ventricles and variable systolic function.
Normal LV dimensions, normal or low fractional shortening %.
Abrupt increase in LV dimension in early diastole (Abrupt posterior motion of LVPW and anterior motion of IVS) followed by no further increase in dimensions (i.e. flat LVPW & IVS throughout the rest of diastole)
Abrupt cessation of filling creates a jerky, spasmodic wall motion.
Doppler fl0w pattern:
Peak E and % of E area - Normal
Peak A & % of A area - Decreased
Therefore, E/A ratio is increased.
Mitral Deceleration Time:
Decreased less than 150 ms
LV. IVRT (Isovolumic relaxation time) - shorter
Mechnism of short deceleration time (MV): Rapid equalization of LVEDP and Atrial pressure(corresponds to "Rapid filling wave" in LV trace in cath lab).
Further shortening of TV deceleration occurs with inspiration (Increased filling -> septum bows to left -> Decreases LV diastolic function.
Mid-diastolic MR or TR (correspond to peak of rapid filling wave)
Systemic venous flow pattern:
1) Decreased forward flow during systole
2) Increased or prolong flow reversal during atrial contraction (worse during inspiration)...Reflects decreased RV compliance.
Diastolic forward flow in MPA (during inspiration)