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Select the one best answer for each of the following questions.

1. In patients with LV systolic dysfunction, elevation of PCWP is likely to occur when E-wave DT is:

a. <220 ms

b. >300 ms

c. <150 ms

d. <300 ms

e. >150 ms

c. In patients with left ventricle systolic dysfunction an E-wave DT less than 150 ms correlates with grade III diastolic dysfunction (restrictive filling pattern), characterized by elevated filling pressures and PCWP. A DT value between 150 and 220 ms (choices a and e) may represent grade II diastolic dysfunction (pseudonormal pattern) with elevated fillings pressures; however, this cannot be confirmed solely on the base of DT—other echocardiographic indicators are necessary.

2. Which of following statements concerning IVRT is incorrect?

a. IVRT is the interval between aortic valve closure and onset of mitral inflow.

b. IVRT represents the interval between LV relaxation and LV pressure decline.

c. IVRT is influenced by the velocity of active relaxation.

d. IVRT is influenced by the aortic pressure and the atrial pressure.

e. IVRT is best acquired from a deep transgastric long-axis view.

b. IVRT is the interval during which LV relaxation occurs and consequently LV pressure declines until LV pressure is less than the left atrial pressure, leading to the opening of the mitral valve and to the beginning of the rapid diastolic filling.

3. Transmitral Doppler flow in patients with isolated relaxation abnormality and normal LV filling pressure is characterized by:

a. Decreased IVRT

b. Decreased early diastolic peak velocity

c. Decreased DT of the E wave

d. Increased E/A ratio

e. Decreased late diastolic peak velocity

b. Isolated relaxation abnormality with normal filling pressures represents grade I diastolic dysfunction (impaired relaxation) characterized by increased IVRT, decreased E-wave velocity, increased DT of the E wave, and decreased E/A ratio.

4. Transmitral Doppler flow peak E velocity is dependent on all of the following except:

a. Active left ventricular relaxation

b. Myocardial elastic properties

c. Left atrial pressure

d. Left atrial contraction


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