ARDMS Echo Hemodynamic Assessment 1 — Questions and Answers
Question 1: Which echocardiographic parameter non-invasively estimates pulmonary capillary wedge pressure (PCWP)?
- Mitral A wave velocity
- E/e' ratio (mitral E / tissue Doppler e') (Correct answer)
- Tricuspid annular velocity
- RVOT acceleration time
Correct answer: E/e' ratio (mitral E / tissue Doppler e')
E/e' >14 (average of septal and lateral) correlates with elevated PCWP and is an ASE/EACVI recommended parameter for LV filling pressure estimation.
Question 2: The inferior vena cava (IVC) collapses less than 50% with sniff in a patient with a dilated IVC (>2.1 cm). What RAP estimate does this suggest?
- 0–5 mmHg
- 5–10 mmHg
- 10–15 mmHg
- ≥15 mmHg (Correct answer)
Correct answer: ≥15 mmHg
A dilated IVC (>2.1 cm) with <50% inspiratory collapse estimates a high right atrial pressure of ≥15 mmHg per ASE guidelines.
Question 3: Which finding on M-mode or 2D echo suggests elevated left ventricular end-diastolic pressure (LVEDP)?
- Tall mitral E wave with short deceleration time and B-bump on M-mode mitral valve (Correct answer)
- Low E/A ratio with prolonged IVRT
- Dilated IVC with plethora
- Increased TAPSE
Correct answer: Tall mitral E wave with short deceleration time and B-bump on M-mode mitral valve
Elevated LVEDP causes a B-bump (notch on the anterior mitral leaflet M-mode tracing) and a short mitral E deceleration time indicating rapid equalization of LA and LV pressures.
Question 4: Stroke volume (SV) using echocardiography is calculated as:
- LVOT VTI × LVOT cross-sectional area (Correct answer)
- LVOT VTI / LVOT diameter
- LVOT diameter × peak LVOT velocity
- LVOT VTI × heart rate
Correct answer: LVOT VTI × LVOT cross-sectional area
SV = LVOT VTI × LVOT CSA (π × r²), combining the stroke distance with the outflow tract cross-sectional area to yield volume per beat.
Question 5: A patient has a TR peak velocity of 3.5 m/s and estimated RAP of 10 mmHg. What is the estimated RVSP?
- 39 mmHg
- 49 mmHg
- 59 mmHg (Correct answer)
- 69 mmHg
Correct answer: 59 mmHg
RVSP = 4 × (3.5)² + 10 = 4 × 12.25 + 10 = 49 + 10 = 59 mmHg.
Question 6: Which finding indicates equalization of diastolic pressures across the pericardium in constrictive pericarditis?
- Exaggerated respiratory variation in mitral inflow with septal bounce and dilated IVC (Correct answer)
- Uniform diastolic filling without respiratory variation
- Reduced E/e' ratio with normal IVC
- Systolic flow reversal in pulmonary veins alone
Correct answer: Exaggerated respiratory variation in mitral inflow with septal bounce and dilated IVC
Constrictive pericarditis shows exaggerated mitral/tricuspid respiratory variation (ventricular interdependence), septal bounce, and plethoric non-collapsing IVC.
ARDMS Echo Hemodynamic Assessment 1
Which echocardiographic parameter non-invasively estimates pulmonary capillary wedge pressure (PCWP)?