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EACVI Echo Handbook - sample

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Chapter 2 The Standard

Chapter 2 The Standard Transthoracic Echo Examination 2.2 Doppler echocardiography Doppler echocardiography Provides information regarding blood flow: ◆◆ direction - towards the transducer ◆◆ colour flow coded red (Fig. 2.2.1 LV inflow) ◆◆ spectral display above baseline (Fig. 2.2.2 LV inflow) ◆◆ away from the transducer ◆◆ colour flow coded blue (Fig. 2.2.3 LV outflow) ◆◆ spectral display below baseline (Fig. 2.2.4 LV outflow) ◆◆ velocity = spectral display distance from baseline ◆◆ amplitude = spectral display signal brightness Allows assessment of valves, haemodynamics, and coronary flow reserve through: ◆◆ calculation of valve gradient (stenosis) and functional area (stenosis, regurgitation) ◆◆ calculation of SV (stroke volume), CO (cardiac output), dP/dt, intracardiac pressures, intracardiac shunt, and coronary flow reserve (CFR) ◆◆ colour Doppler lesion detection: convergence zone (stenosis, regurgitation) or regurgitant jet ◆◆ estimation of LV filling pressure/diastolic function V Fig. 2.2.1 LV inflow V Fig. 2.2.3 LV outflow Fig. 2.2.2 LV inflow Fig. 2.2.4 LV outflow 24

2.3 Functional echocardiography General considerations Functional imaging by modern echocardiography offers a variety of methods to assess regional and global myocardial function beyond classic dimension, volume, and ejection fraction measurements Information on myocardial function is extracted from echo images using either a tissue Doppler or a speckle-tracking approach. Both approaches are valid and useful but differ in their strengths and weaknesses, the optimal machine settings for image acquisition, the way of post-processing, and the obtained parameters Four basic parameters are extracted: ◆◆ Velocity ◆◆ Motion (displacement) ◆◆ Strain rate (rate of deformation) (Table 2.3.3) ◆◆ Strain (deformation) (see Tables 2.3.4, 2.3.5, 2.3.6) All echocardiographic function parameters are load-dependent. When interpreting functional imaging parameters, factors influencing regional myocardial fibre load, such as chamber geometry, wall curvature, and thickness or cavity pressure, must be considered The EACVI Echo Handbook 49

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