Jae K. Oh
409 posts
Jae K. Oh
@JaeKOh2
Cardiac Hemodynamics, Diastology, Pericardial Diseases, Valvular HD
EVOID AS Trial & ECG/Echo AI
Mayo Clinic Rochester
Joined January 2014
- Replying to @JaeKOh2 @HeartDocSharon and 6 othersAnother critical Echo feature of constrction is preserved (>= 8cm/s) or ⬆️ mitral Medial Annulus e' velocity which is ⬇️ in ALL MYOCARDIAL DISEASES. When CP is mixed with myopathy, e' is lower than that in pure CP. Constriction until proven otherwise when e' is⬆️ in HF patient!
00:00 - #0/7 Thanks @purviparwani for robust discussion on diastology which means "Dilation". I was asked to present my approach to Diastolic Function assessment at @ase360 " Just Relax: Diastolic Dysfunction" session. Let me share again and explain the 7 points that I emphasized.
- Replying to @HeartDocSharon @MayoClinicCV and 5 othersThanks for tweeting this @HeartDocSharon who gave a great contrast talk @ASE360. Here is real time animation #LivHatle and we @MayoClinicCV put together 20 years ago. The best demonstration of constriction hemodynamics. Do not miss constriction which is a CURABLE Diastolic HF.
00:00 - A 65 yo pt was referred to cardiac surgery for pericardiectomy with CT and cath (see below) consistent with constriction. Intraoperative @ase TEE was performed by an outstanding anesthesiologist. What do you think he said to the surgeon who is about to do sternotomy? @aae_echo
00:00 - It is a myth that diastolic function is always abnormal in patients with systolic dysfunction. Young patients with reduced EF can have normal DF and filling pressure. Shown below was obtained from a 40 year old woman with LVEF of 25%. Filling pressure is normal. @jamil_tajik
Replying to @apuxty @Wilkinsonjonny and 3 othersFor me that’s a problem, and there are several actually: 1. Diagnosing anyone with systolic dysfunction with diastolic dysfunction is pointless as by definition the two go together 2. In ICU loading conditions constantly change so what looks like grade 1 can actually be grade 2 - If septal e’>15, diastolic function is NORMAL - no additional assessment is needed. @JaeKOh2 #CVIECHO2020
- 1/5 My Dx for the e' velocity of 4 cm/s is reduced myocardial relaxation, which is sine qua non of diastolic dysfunction. It is present in all forms of myocardial disease and also with aging. Let me explain its progression & how to use the information for our pts @MayoClinicCV
- Replying to @argulianThis HV Doppler shows increased inspiratory diastolic flow reversal cw high RV DP due to a myocardial disease. The last cycle was with inspiration since forward flow velocity increased. Diastolic reversal happens with expiration in constriction. @jamil_tajik Not TR! @EchoCases
- 1/3. @EleidMack asked me to review Echo which was interpreted as normal. Looking at closely, Echo shows a subtle septal motion change. M-mode of LV would have shown septal motion change more clearly. Mitral inflow velocity showed >25% respiratory variation suggestive of CP.
- 1/2 Just received a box of chocolate from my pt who underwent pericardiectomy during COVID by @MayoClinicCVS after several yrs of HF elsewhere. Had numerous thoracenteses and liver evaluations including a biopsy. #Echo diagnosed CP using #Hatle and @MayoClinicCV dx criteria.
- Doppler, Color M mode, and strain from a patient with HCM. A good example of short IVRT and "L" wave indicating increased filling pressure. E velocity flow propagation velocity does not work in a small LV as in HCM.@jamil_tajik @ASE360 @aae_echo @KyleWKlarich @DavidWienerMD
- From @MayoClinicCV #hemody session. PV premature diastolic opening is related to increased RVEDP, but not necessarily increased mean RV diastolic pressure. (See 2 examples below) Same in the LV. @jamil_tajik @ASE360 @aae_echo @EchoCases
