ICUIdea

Etapele sistolei

1. Contractia izovolumetrica
2. Faza de ejectie
   • de accelerare flux aortic
   • de decelerare flux aortic

Functia sistolica a LV se apreciaza ca variatii ale LV in forma si marime

• global vs regional
• cantitativ vs calitativ

Functia longitudinala a VS – MAPSE + TDI

LINIAR

• Fractia de scurtare = FS
  • se apreciaza in PLAX sau PSAX
  • N ≥ 30 %
  • Disfunctie severa daca scade < 20 %
  • ! BRS, pacemaker, miscari anormale ale IVS, RWMA, foreshortening

• MAPSE
  • miscarea apicala a inelului mitral datorata fibrelor longitudinale
  • A4C – M Mode – inel septal/lateral
  • ≥ 11 ♂
  • ≥ 13 ♀
  • < 8 → LVEF < 50%\

• E point septal separation = EPSS
  • PLAX – M Mode cursor prin varful valvei mitrale → punctul cel mai inalt al primului varf
  • ALMV aproape atinge IVS in early diastola
  • EPSS > 7 mm → LVEF < 50%

2 D

• Fractional Aria Change = FAC
  • N = 35 – 65 %

3D

• Masurare volum Simpson’s in A4C/A2C
  • Sumatia discurilor de-a lungul axei lungi a LV
  • V = ∑πr²h
  • N > 55%
  • supraestimata – MR
  • subestimata – MS
  • LVEDV > 200 sau LVESV > 85 → sever

GROSIME PERETI

• PLAX – MMode – la vf foitelor mitralei la sf diastolei
• Calitativ
  • hiper, normal, moderat, sever
  • miscare inel mitral
  • ingrosare pereti
  • ALMV atinge septul
• Circumferential fibre shortening (Vcf)

• LEVT = left ventricular ejection time
• N = 1.09 ±\pm 0.3 cm/sec

LV STRAIN

= Δ lungimii intr-o directie relativa la lungimea initiala

GLS = Global Longitudinal Strain

! miocardul nu se scurteaza in sistola – MLs < MLd → GLS va fi tot timpul negativ!

Probleme:

• endocardial drop out
• foreshortening

Aplicatii clinice GLS:

• HVS
• cardio-toxicitate
• b valvulara asimptomatica
• CAD
• IC

DOPPLER

• dp/dt
  • pe curba de accelerare a MR
  • dp intre 1 – 3 m/sec 

• N > 1200 mmHg/sec< 600 mmHg/s insuficienta cardiaca severa

SV	70 – 110 ml
CO	5 – 8,5 l/min
CI	> 2.5 l/min/m2
VTI	18 – 22 cm

• Determinarea DC
  • Volumetric

CO = (LVEDV – LVESV) x HR

• Spectral

• Indice TEI
  • indice de performanta miocardica
  • aprecieaza global functia LV: sistola + diastola

N = 0.36 ∓ 11 %

• Unda S doppler tisular
  • N > 8 cm/s
  • < 5 cm/s → LVEF < 50%