Echocardiogram Hemodynamics and Doppler Assessment 2 — Questions and Answers
Question 1: Cardiac output by Doppler echocardiography is calculated using which formula?
- CO = HR × SV, where SV = LVOT area × LVOT VTI (Correct answer)
- CO = HR × EF × LV volume
- CO = 4V² × heart rate
- CO = LV mass / heart rate
Correct answer: CO = HR × SV, where SV = LVOT area × LVOT VTI
Cardiac output equals heart rate multiplied by stroke volume, where stroke volume is calculated as LVOT cross-sectional area times LVOT VTI.
Question 2: A mitral inflow pattern showing E/A ratio >2 with short deceleration time (<150 ms) is consistent with which grade of diastolic dysfunction?
- Grade I (impaired relaxation)
- Grade II (pseudonormal)
- Grade III (restrictive), reversible or irreversible (Correct answer)
- Normal diastolic function
Correct answer: Grade III (restrictive), reversible or irreversible
Grade III diastolic dysfunction (restrictive filling) is characterized by E/A >2, short deceleration time <150 ms, reflecting markedly elevated filling pressures.
Question 3: Which Doppler finding on pulmonary vein analysis supports elevated left atrial pressure?
- Dominant S wave (S > D)
- Systolic flow reversal or blunted S wave (S < D) (Correct answer)
- Normal A-wave duration
- Increased pulmonary vein D velocity
Correct answer: Systolic flow reversal or blunted S wave (S < D)
Elevated LA pressure blunts or reverses the systolic pulmonary vein flow component, resulting in S < D or systolic flow reversal.
Question 4: The isovolumetric relaxation time (IVRT) is measured as the interval between:
- Mitral valve opening and closure
- Aortic valve closure and mitral valve opening (Correct answer)
- QRS onset and mitral E wave
- Tricuspid and mitral valve closure
Correct answer: Aortic valve closure and mitral valve opening
IVRT is the interval from aortic valve closure to mitral valve opening, representing the period of LV pressure decline before filling begins.
Question 5: In assessing right ventricular systolic pressure (RVSP) non-invasively, which Doppler measurement is used?
- Pulmonary valve peak gradient
- Tricuspid regurgitation peak velocity (Correct answer)
- Right ventricular outflow tract VTI
- Pulmonic valve deceleration time
Correct answer: Tricuspid regurgitation peak velocity
RVSP = 4 × (TR peak velocity)² + estimated RAP, using the modified Bernoulli equation applied to the tricuspid regurgitation jet.
Question 6: Doppler tissue imaging (DTI) measures which type of myocardial motion?
- Blood flow velocities within cardiac chambers
- Myocardial wall velocities (low velocity, high amplitude signals) (Correct answer)
- Coronary artery flow reserve
- Pericardial motion only
Correct answer: Myocardial wall velocities (low velocity, high amplitude signals)
DTI uses high-pass filters to reject blood flow signals and records low-velocity, high-amplitude myocardial wall motion velocities.
Echocardiogram Hemodynamics and Doppler Assessment 2
Cardiac output by Doppler echocardiography is calculated using which formula?