CET Doppler Echocardiography & Spectral Analysis 2 — Questions and Answers
Question 1: The E/e' ratio obtained by combining mitral inflow E wave and tissue Doppler e' velocity is used to estimate:
- Left ventricular ejection fraction
- Left atrial pressure and diastolic filling pressures (Correct answer)
- Right ventricular systolic pressure
- Aortic valve area
Correct answer: Left atrial pressure and diastolic filling pressures
The E/e' ratio correlates with left ventricular filling pressure (LVEDP/PCWP) and is a key parameter in grading diastolic dysfunction.
Question 2: Which Doppler finding is characteristic of constrictive pericarditis when compared to restrictive cardiomyopathy?
- Increased E/A ratio with prolonged deceleration time
- Respiratory variation >25% in mitral E-wave velocity (Correct answer)
- Reduced tissue Doppler e' velocity below 7 cm/s
- Absent hepatic vein diastolic flow reversal
Correct answer: Respiratory variation >25% in mitral E-wave velocity
Constrictive pericarditis typically shows >25% respiratory variation in mitral inflow E-wave velocity due to ventricular interdependence, unlike restrictive cardiomyopathy.
Question 3: Proximal isovelocity surface area (PISA) is used in echocardiography to calculate:
- Left ventricular volume
- Regurgitant flow rate and effective regurgitant orifice area (Correct answer)
- Cardiac output from aortic Doppler
- Pulmonary artery pressure
Correct answer: Regurgitant flow rate and effective regurgitant orifice area
PISA uses the hemisphere of flow convergence proximal to a regurgitant orifice to quantify regurgitant flow rate and effective regurgitant orifice area (EROA).
Question 4: When measuring the aortic valve area by the continuity equation, which three parameters are required?
- LVOT diameter, LVOT VTI, and aortic VTI (Correct answer)
- Peak aortic velocity, mean gradient, and valve area
- LVOT VTI, heart rate, and body surface area
- Aortic VTI, left atrial volume, and ejection fraction
Correct answer: LVOT diameter, LVOT VTI, and aortic VTI
The continuity equation (A1×VTI1 = A2×VTI2) requires LVOT cross-sectional area (from diameter), LVOT VTI, and aortic jet VTI to calculate aortic valve area.
Question 5: In a patient with mitral regurgitation, the vena contracta is best defined as:
- The width of the color jet at the level of the mitral annulus
- The narrowest portion of the regurgitant jet just distal to the orifice (Correct answer)
- The largest diameter of the regurgitant jet in the left atrium
- The area of flow convergence proximal to the valve
Correct answer: The narrowest portion of the regurgitant jet just distal to the orifice
The vena contracta is the narrowest cross-section of the regurgitant color jet, located immediately downstream from the orifice, and directly reflects orifice size.
Question 6: What does a peak tricuspid regurgitation jet velocity of 3.5 m/s indicate when estimating right ventricular systolic pressure (RVSP)?
- RVSP ≈ 29 mmHg plus right atrial pressure
- RVSP ≈ 49 mmHg plus right atrial pressure (Correct answer)
- RVSP ≈ 12 mmHg plus right atrial pressure
- RVSP ≈ 16 mmHg plus right atrial pressure
Correct answer: RVSP ≈ 49 mmHg plus right atrial pressure
Using 4V², the gradient = 4×(3.5)² = 49 mmHg; RVSP = TR gradient + estimated right atrial pressure.
Question 7: Pulmonary vein Doppler showing blunted systolic (S) wave with predominant diastolic (D) wave and prominent atrial reversal (Ar) suggests:
- Normal diastolic function
- Elevated left atrial pressure and impaired relaxation grade III or IV (Correct answer)
- Severe aortic stenosis
- Right heart failure with volume overload
Correct answer: Elevated left atrial pressure and impaired relaxation grade III or IV
Blunted pulmonary vein S wave with dominant D wave and Ar duration >30 ms longer than mitral A duration indicates elevated left atrial pressure, consistent with advanced diastolic dysfunction.
CET Doppler Echocardiography & Spectral Analysis 2
The E/e' ratio obtained by combining mitral inflow E wave and tissue Doppler e' velocity is used to estimate: