I guess my question was too vague. I understand the
diastolic function properties that you discussed. I
guess what I am asking is if my cardiologists are not
interested in measurements for the TDI and the mitral
inflow and valsalva are e/a reversed, does doing TDI
and/or pulm vein inflow tell me anything more to add
or dispute that. I am trying to become more efficient
without losing diagnostic quality. So for example, a
patient whom has atrial fibrillation or flutter
doesn't need to have their pulm vein or TDI pulsed or
valsalva performed because there is no acceptable a
wave. So, when I am doing an exam and I encounter for
example normal e/a in mitral inflow and valsalva, and
all else appears normal, will pulm vein inflow tell me
much extra? TDI? Thanks for your help.

Sean


--- vuedoc@... wrote:

> Valsalva, or any preload reducing maneuver
> (including administering
> nitroglycerine) will reduce trans-mitral flow
> velocities overall. In someone with
> normal myocardial properties of relaxation and
> compliance, i.e., normal E/A,
> both peaks will be attenuated. The same thing
> should happen in a patient with
> impaired LV relaxation who demonstrates E/A
> reversal.
>
> Now, in a patient with a pseudonormal trans-mitral
> pattern who has an
> apparently normal E/A ratio but also has reduced
> ventricular compliance with
> elevated left-sided filling pressure, decreasing
> preload will reduce the velocity
> of the rapid filling phase (E-wave), but not that of
> atrial contraction
> (A-wave), revealing an E/A reversal pattern. Thus,
> performing Valsalva on such a
> patient will "unmask" a pseudonormal pattern and
> reveal evidence of diastolic
> dysfunction with mean left atrial pressures that are
> at least moderately
> elevated.
>
> A cool trick, and very useful for evaluating
> diastolic function and
> pressures when tissue Doppler and pulmonic vein
> analysis are not possible.
>
> Bradley J. Artel, MD, FACC
> New York City
>


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