CET CET Hemodynamic Assessment & Measurements 2 — Questions and Answers
Question 1: Which Doppler measurement is used to assess right ventricular dP/dt?
- Peak tricuspid annular systolic velocity (S')
- Rate of rise of the tricuspid regurgitation CW Doppler signal between 1 and 3 m/s (Correct answer)
- Right ventricular outflow tract acceleration time
- Hepatic vein systolic reversal fraction
Correct answer: Rate of rise of the tricuspid regurgitation CW Doppler signal between 1 and 3 m/s
RV dP/dt is estimated from the TR CW Doppler signal by measuring the time for TR velocity to rise from 1 to 3 m/s, analogous to the LV dP/dt method using MR.
Question 2: What does a TAPSE (tricuspid annular plane systolic excursion) value of <17mm indicate?
- Normal right ventricular systolic function
- Mildly reduced right ventricular systolic function (Correct answer)
- Severely reduced right ventricular systolic function
- Normal left ventricular diastolic function
Correct answer: Mildly reduced right ventricular systolic function
TAPSE <17mm indicates abnormal (reduced) right ventricular systolic function per ASE guidelines, with values 10–16mm suggesting moderate dysfunction.
Question 3: The inferior vena cava (IVC) diameter and its respiratory variation are used to estimate which hemodynamic parameter?
- Left atrial pressure
- Right atrial pressure (Correct answer)
- Pulmonary capillary wedge pressure
- Cardiac output
Correct answer: Right atrial pressure
IVC diameter and collapsibility index are used to estimate mean right atrial pressure; a dilated IVC (>2.1cm) with <50% collapse suggests RAP ≥10–15 mmHg.
Question 4: Which Doppler parameter is used to assess left ventricular relaxation in diastolic dysfunction grading?
- Mitral E/A ratio alone
- Septal and lateral mitral annular e' velocities (Correct answer)
- Pulmonary artery acceleration time
- Left ventricular outflow tract VTI
Correct answer: Septal and lateral mitral annular e' velocities
Mitral annular e' velocities (septal <7 cm/s, lateral <10 cm/s) measured by tissue Doppler imaging reflect myocardial relaxation and are central to diastolic dysfunction grading.
Question 5: What is the significance of a mitral valve deceleration time (DT) of less than 150ms?
- Normal diastolic function
- Impaired relaxation pattern (grade I diastolic dysfunction)
- Restrictive filling pattern suggesting elevated LV filling pressures (Correct answer)
- Pseudonormal filling pattern
Correct answer: Restrictive filling pattern suggesting elevated LV filling pressures
A mitral deceleration time <150ms indicates a restrictive filling pattern (grade III diastolic dysfunction) associated with markedly elevated LV filling pressures.
Question 6: Which formula correctly calculates cardiac output (CO) using echocardiographic measurements?
- CO = LV end-diastolic volume × heart rate
- CO = LVOT CSA × LVOT VTI × heart rate (Correct answer)
- CO = Peak aortic velocity × LVOT diameter
- CO = Mean mitral gradient / heart rate
Correct answer: CO = LVOT CSA × LVOT VTI × heart rate
Cardiac output = stroke volume × heart rate = (LVOT CSA × LVOT VTI) × heart rate, measured using pulsed-wave Doppler at the LVOT.
CET CET Hemodynamic Assessment & Measurements 2
Which Doppler measurement is used to assess right ventricular dP/dt?