Echo: Abnormal Ventricular Diastolic Function

Extract from Snider's Echo book (Restrictive Cardiomyopathy):

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:
MV Doppler:
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)

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