超声心动图实用手册Practical Manual of Echocardiography_部分27精品.pdfVIP

Acute dyspnea and heart failure | 221 E/e’ of 8–15 is indeterminate; elevated pressures are suggested by one or more: SPAP ≥35 mm Hg (in absence of pulmonary disease); a change in E/A ratio with the Valsalva maneuver of 0.5; systolic peak velocity/diastolic peak velocity ratio in pulmonary venous flow of 1 measured by PW Doppler. In patients with normal EF (Figure 15.4): E/e’ ≤8 at either annulus suggest normal filling pressures. Average E/e’ ≥ 13 suggest elevated filling pressures (≥12 lat and ≥15 sep annulus). E/e’ of 9–12 is indeterminate; elevated pressures are suggested by any of the following: SPAP ≥ 35 mm Hg (in absence of pulmonary disease); a change in E/A ratio with the Valsalva maneuver of 0.5. 2 maximal LA volume ≥ 34 ml/m . It is important to note that the E/e’ ratio is not accurate as an index of filling pressures in patients with heavy annular calcification and constrictive pericarditis. The latter should be suspected when the patient presents in predominant right heart failure, has a normal EF, and the tissue Doppler e’ is ≥ 8 cm/s. An indicator of high LVEDP is the presence of a “B-bump” on M-mode echocardiography of the mitral valve (Figure 15.5). Although rarely seen, when is noted it is indicative of high LV filling pressures. Normal EF E/e of 9–12 is E/e ≤ 8 at either annulus Average E/e ≥ 13 indeterminate; elevated suggest normal filling suggest elevated filling pressures are suggested pressures