ARDMS Echo Hemodynamic Assessment 2 — Questions and Answers
Question 1: The RVOT acceleration time (AT) is used to estimate mean pulmonary artery pressure. Which formula applies?
- mPAP = 90 − (0.62 × AT)
- mPAP = 4 × (PR velocity)²
- mPAP = 79 − (0.45 × AT) (Correct answer)
- mPAP = TR velocity² × 4 + RAP
Correct answer: mPAP = 79 − (0.45 × AT)
mPAP ≈ 79 − (0.45 × RVOT AT in ms) is a validated formula; shorter AT corresponds to higher pulmonary artery pressure.
Question 2: In a patient with severe aortic regurgitation, which Doppler measurement reflects the severity of diastolic aortic regurgitation?
- Peak AR jet velocity
- Pressure half-time of the AR jet (shorter = more severe) (Correct answer)
- Peak LVOT velocity
- Mitral E/A ratio
Correct answer: Pressure half-time of the AR jet (shorter = more severe)
A short AR jet pressure half-time (<200–300 ms) indicates rapid equalization of aortic and LV diastolic pressures, signifying severe AR.
Question 3: Which non-invasive Doppler parameter is used to calculate systemic vascular resistance (SVR)?
- (Mean arterial pressure − mean RAP) / cardiac output (Correct answer)
- Peak TR velocity / RVOT VTI
- LVOT VTI × LVOT area
- E/e' ratio × heart rate
Correct answer: (Mean arterial pressure − mean RAP) / cardiac output
SVR = (MAP − RAP) / CO, where MAP and RAP can be estimated echocardiographically and CO is derived from LVOT stroke volume.
Question 4: Diastolic dysfunction grading (Grades I–III) is classified using which combination of parameters per ASE 2016 guidelines?
- LVEF, LV mass, and wall motion score
- E/A ratio, E/e' ratio, LAVI, and TR velocity (Correct answer)
- TAPSE, IVC size, and RV area
- MV deceleration time, LVEF, and RVSP
Correct answer: E/A ratio, E/e' ratio, LAVI, and TR velocity
The 2016 ASE/EACVI algorithm uses E/A ratio, average E/e', LAVI, and peak TR velocity to classify diastolic dysfunction severity.
Question 5: Cardiac output measured by the Fick method requires which echocardiographic input?
- No echocardiographic input needed
- Doppler-derived cardiac output from LVOT (Correct answer)
- LV volumetric data (Simpson's method)
- Tissue Doppler annular velocities only
Correct answer: Doppler-derived cardiac output from LVOT
Echo-derived cardiac output (CO = SV × HR from LVOT VTI method) can be used alongside or in place of the Fick method in the catheterization lab.
Question 6: What echocardiographic sign is consistent with cardiac tamponade physiology?
- Dilated IVC without respiratory variation, diastolic RV collapse, and exaggerated respiratory variation in tricuspid and mitral inflow (Correct answer)
- Increased TAPSE with normal IVC
- Restrictive mitral inflow without respiratory variation
- Septal bounce without IVC plethora
Correct answer: Dilated IVC without respiratory variation, diastolic RV collapse, and exaggerated respiratory variation in tricuspid and mitral inflow
Tamponade is evidenced by a plethoric IVC, diastolic RV free wall collapse, early diastolic RA collapse, and >25–40% respiratory variation in AV valve inflow velocities.
ARDMS Echo Hemodynamic Assessment 2
The RVOT acceleration time (AT) is used to estimate mean pulmonary artery pressure.
Which formula applies?