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-----------------------------

1)M¸ðµå ¹°¸®ÇÐ :   transducer¸¦ ÅëÇØ ³»º¸³½ ultrasound beamÀÌ ÇغÎÇÐÀû±¸Á¶¹°»çÀÌÀÇ Ç¥¸é¿¡ ºÎµúÈ÷¸é ¹Ý»çÆĸ¦ ¸¸µå´Âµ¥, dots (B- mode) or spikes (A-mode)·Î¼­ ŽÃËÀÚ¿¡ °¨ÁöµÇ¸ç ÀÌ´Â ±× ÁøÆø¿¡ µû¶ó ±× ¹üÀ§°¡ ´Þ¶óÁö°í B-mode½ºÄµ¿¡ ½Ã°£Á¶°ÇÀ» ÁÖ°í Á¿ì·Î ÆîÃijõÀº °ÍÀÌ M¸ðµå¿µ»óÀÌ´Ù

---µû¶ó¼­, ´õ ÁÁÀº temporal resolution À» ¾òÀ» ¼ö ÀÖ°Ô µÇ°í, ±¸Á¶¹°ÀÇ motion and timing ¿¡ À־ ¹Ì¹¦ÇÑ ºñÁ¤»ó¼Ò°ßµéÀ» º¸´Ù Àß Æò°¡ÇØ ³¾ ¼ö ÀÖ´Ù..±× ÀûÀýÇÑ ¿¹·Î¼­´Â  systolic anterior motion (SAM)of mitral valve in HCM & RV diastolic collapse in tamponadeµîÀÌ ÀÖ´Ù. high sampling frequency¸¦ ¿øÇÑ´Ù¸é ÃÊ´ç1000ȸ±îÁöµµ Á¦°øÇØ ÁֹǷΠM¸ðµå½ºÄµÀº ¶Ù¾î³­ axial resolution À» ¾òÀ» ¼ö ÀÖ°í ¿¬°üµÈ ±¸Á¶¹° À§Ä¡°ú ±× ¿òÁ÷ÀÓÀÇ ¹üÀ§¸¦ µ¿Á¤Çϴµ¥¿¡ ¸Å¿ì À¯¿ëÇϸç ÀÌ·Î½á ±¸Á¶¹°ÀÇ ¸ð¾çµé, Áï ½ÉÀåÆǸ·ÀÇ ¿òÁ÷ÀÓ°ú ¼Óµµ, ÁøÇà¾ç»óÀ» ¾Ë ¼ö ÀÖ´Ù(ÁøÆø, ¼Óµµ, ½Ã°£°£°Ý, ¸ð¾ç)

2)½Â¸ðÆǸ·.....2 leaflets – anterior and posterior.

===Mitral stenosis[ÇùÂø]: Decrease EF slope(¹ÚÃâÇ÷¾×·®À» ÃÖ´ëÇÑ Á½ɽdz»·Î µé¿©º¸³»±â À§ÇÔ)..... Paradoxical anterior diastolic motion(PADM) of PML.(ÆǸ·°£ °æÈ­/À¯ÇÕÀ¸·Î ÀÎÇØ) =.dec. Seperation between leaflets /Thickening of leaflets.....Early diastolic dip of IVS(ÆǸ·ÀÇ ¿ÀÇØ??)......Reduced mitral valve leaflet excursion( D-E excursionÀÏÅ»....DE»çÀÌ¿¡ Á¤»óÀûÀ¸·Î ³ªÅ¸³ª´Â, Ç÷·ùÀ¯ÀÔ·®ÀÇ Áõ°¡¿¡ µû¶ó ¿òÁ÷ÀÌ´Â ÆǸ·ÀÇ ¿îµ¿¼ÓµµÂ÷ÀÌ·Î ÀÎÇØ ¸¸µé¾îÁö´Â V-¸ð¾ç)......ÀÌ°ÍÀÌ »ç¶óÁüÀ¸·Î ÀÎÇØ À¯¹ßµÇ´Â °ÍÀÌ Earlier pliability(Á¶±âÀ¯¿¬¼º....ÆǸ·ÀÌ »¡¸® ÆìÁü=ÆǸ·ÀÇ IVS¸¦ ÇâÇÑ »ó´ëÀû Áøµ¿ÆøÀº Áõ°¡) for BMV(= D- E amplitude.20mmÀÌ»óÀ¸·Î Áõ°¡). 

===Mitral regurgitation[¿ª·ù] : ÀÌ °æ¿ìÀÇ  m-mode ¼Ò°ßµéÀº ´ëü·Î °£Á¢¼Ò°ßµéÀÓ----LA enlargement, LV enlargement.....Exaggerated septal motion (>1cm...½É½Ç³» À¯ÃâÀÔÇ÷·ù·® Áõ´ë·Î ÀÎÇØ ±×¸¸Å­ IVSÀÇ ÁøÆøº¯È­°¡ Ä¿Áü )...... LAE with systolic expansion of the posterior left atrial wall.

=== Mitral valve prolapse[Å»Ãâ] : .....Thick redundant mitral valve leaflets...........Mid to late systolic sagging back of the anterior, posterior or both MV leaflet >2mm from C-D point (°¡»ó±âÁؼ±)of MV..........¶§·Î´Â Holosystolic sagging back of the anterior, posterior, or both MV leaflet >3mm from the C-D point of MV.

===Flail mitral leaflet(¸¶Ä¡ äÂïó·³ ÈÖ¾îÁüÀÌ Áõ°¡ÇÑ µµ¸®±úÇüMV) : .....Coarse diastolic fluttering of mitral leaflets.......Flail mitral leafletÈçÀûÀÌ LA¾È¿¡¼­±îÁöµµ °üÂûµÊ

=== Infective endocarditis[°¨¿°¼º½É³»¸·¿°]: “smudged”, “shaggy”(ÆǸ·¸ð¾çÀÌ ¾ó·èÁö°í ³Ê´ú³Ê´úÇÔ)..... ÇÑÆí, ÆǸ·¿¡ ´Þ¶óºÙÀº ºÎÂø¹°(vegetation)Àº ÆǸ·¿òÁ÷ÀÓÀ» Á¦ÇÑÇÏÁö´Â ¾ÊÀ½.

=== LA myxoma[Á½ɹæÁ¡¾×Á¾]: ....Blunted E point of the mitral valve.......Decrease E-F slope....Heavy band of echoes behind the anterior mitral leaflet in diastole (=funnel-shaped ±ò¶§±â»ó)........Echo free space at anterior mitral leaflet at onset of diastole prior to dense echoes from tumor

=== Premature closure [Á¶±âÆó¼â]of MV(ÆǸ·ÀÇ  C-point °¡ ½ÉÀüµµÀÇ QRS complex°¡ ³ª¿À±âÀü¿¡ ¹ßÇö) + MV Fluttering [Á¶µ¿]of AML in aortic regurgitation

=== “B” bump due to elevated EDP B-bump or notch.......A¿ÍC»çÀÌ¿¡ inc. LVEDP·Î ÀÎÇÑ ¼Ò°ß

===Hypertrophic Cardiomyopathy [ºñÈļº½É±ÙÁõ] .....Systolic anterior motion (SAM) of mitral valve s/o dynamic LVOT obstruction

3)´ëµ¿¸ÆÆǸ· == 3 cusps – right coronary, left coronary and non-coronary cusps. ....... Á¤»óÀûÀÎ °æ¿ì PLAX view ¿¡¼­´Â  right coronary and the non-coronary cusps¸¸ ³ªÅ¸³². ....°Ç°­Àο¡°Ô¼­µµ ¶§¶§·Î AVLeaflet ÀÇ fine systolic fluttering À» º¼ ¼öµµ ÀÖÀ½..........AorticRoot, Aortic Valve LA dimension. Aortic Valve  Cusp Separation (ÀüÈÄ1.5-2.5cms in adult) ÃøÁ¤Àº ºö¼±°ú ÀÏÄ¡ÇÏ°ÔÃøÁ¤ --- from leading edge to leading edge.

=== Aortic stenosis[ÇùÂø]: ..... Thickening valve leaflets......Decreased excursion of valve leaflet.......Absence of systolic flutter of aortic valve leaflet.

=== Aortic Valve Bicuspid Valve ÀÌ¿±´ëµ¿¸ÆÆÇ :........ Eccentric closure line (AorticRootÀüº®ÂÊÀ¸·Î Ä¡¿ìħ)

===Aortic regurgitation[¿ª·ù]: ...............Diastolic fluttering of AML. — Diastolic fluttering of aortic valve....... Premature closure of mitral valve..... Premature opening of aortic valve.....Dilated LV............. Fluttering of AML in aortic regurgitation.........Premature opening of Aortic valve in AR......... Diastolic fluttering of aortic valve in AR

===coarse fluttering of aortic valve cusp- SUBAORTIC MEMBRANE[´ëµ¿¸ÆÇÏ ¸·Çü¼º]

===Early closure of AV due to Severe LV dysfun M-mode in a pt with LV dysfunction- showing rounded closure of AV,indicating decrease forward flow at end of systole

=== Systolic notching of AV in HCM

4>Æ󵿸ÆÆǸ· 

ÆǸ·¿òÁ÷ÀÓ== a- downward motion, concides with A-wave of MV; b- represents onset of ventricular systole; c- max downward position ; d- closure begins; e- closure is completed...... In adults it is unusual to record more than posterior leaflet of the pulmonary valve.....In children or in pt with unusually large pulmonary arteries, one may also record anterior leaflet. ......In reality one can rarely record the entire excursion of the pulmonar valve throughout cardiac cycle in adults.  : E-Fslope ==>a-dip/b-recovery-->c :::dowanwardMotion --->:d ::: PVclosure

===Pulmonary stenosis .........increase depth of pulmonary valve “a” wave (increased a-dip)

===Pulmonary HTN with “Flying W sign”(PV opening timeÀÎ d-e»çÀÌ¿¡ ¹ßÇö) ................Pulmonary hypertension m-mode feature- loss of A-dip of pulmonary valve

5)Á¿ì½É½Ç

------FS = LVIDd – LVIDs LVIDd/-----EF = LVIDd3 – LVIDs3 LVIDd3

-----LV Mass = 1.04 {(LVIDd + IVSd + LVPWd)3 – (LVIDd)3} x 0.8 + 0.6g

===LV M-mode parameters range 

-------Ventricular end-diastolic dimension- 37 to 56mm---------Ventricular end-systolic dimension- 26 to 36mm --------- LV diastolic IVS thickness- 7to 11mm ------IVS excursion – 6 to 11mm --------IVS % thickening- 27 to 70% ----------LV posterior diastolic wall thickness- 7 to 11mm -------- LVPW excursion- 9 to 14mm --------LVPW % thickening- 25 to 80% ---------%FS- 28-41% --------EF- 48-78%

===LV parameters….-------Stroke volume- 75 to 100cc.............Cardiac output- 4 to 8L/min .........Cardiac index- 2.4 to 4.2L/min/m2 ........LV mass- male< 294gm; female<198gm ............Mitral valve EF slope- 50 to 150mm/sec ..........DE Excursion- 15 to 25 mm .............. Mitral valve E-point septal seperation- <7mm

===Increase LVW thickness :.....LVPWÀÌ ±âÁØ...LVPWÀÌ µÎ²¨¿öÁö±â½ÃÀÛÇÏ´Â ¼öÃà±â½ÃÀÛÁöÁ¡¿¡¼­ Ãø¤¡Á¤ÇؾßÇÔ..

=== Ischemia ........Normal Wall thickness .......... No systolic thickening .........Reduced Motion

=== Post Infarct........Thin echogenic wall ..........No systolic thickening .........Reduced Motion

=== Dilated Cardiomyopathy......... marked LV dilatation....dec. motion of IVS&LVPW

===Paradoxic Septal Motion : ƯÈ÷ ½ÉÀå¼ö¼úÈÄ

=== Normal E point to septal separation is < 6 mm With reduced lvef, EPSS may be increased.

6)½É¸·

===M¸ðµå½ºÄµ»ó ½É³¶»ïÃâ/´Á¸·»ïÃâ DX point :::  ....: 1)echo free space°¡ Á¡Â÷°¨¼ÒÇÏ´Â ¼Ò°ß– pericardial effusion 2) echo free space°¡ °©Àڱ⠲÷±â´Â ¼Ò°ß- pleural effusion.....½É³¶»ïÃâ¾×Á¤·®Àº M¸ðµå»ó¿¡¼­µµ °¡´ÉÇϳª2D¿¡¼­°¡ ´õ ³´´Ù (ƯÈ÷ ´ë·®À̰ųª ±¹¼ÒÇüÀ϶§)

===Cardiac tamponade- .......Compressed RV (RVID<7mm).......Increase in RV dimension with inspiration and simultaneously decrease in LV dimension during inspiration. ..............Decrease mitral valve EF-slope with inspiration.............. Decrease mitral valve DE-amplitude with inspiration.......RV early diastolic collapse.(specific) ...........RA diastolic collapse.(sensitive) .............Dilated IVC with blunted respiratory changes.(=Plethora)

=== Constrictive pericarditis: .....Pericardial thickening ................Paradoxical septal motion ..... Septal bounce( abrupt displacement of the IVS during early diastole...Ư¡ÀûÀÓ...MS¿Í ºñ±³Çؼ­ ±â¾ïÇ϶ó) .............Flattening of mid & late diastolic motion of the posterior LV wall. ............Rapid early diastolic, or E-F, slope of the mitral valve. ............Rapid downward motion of the posterior aortic wall in early diastole......... Premature opening of pulmonary valve .........Dilated IVC with blunted respiratory changes.

7)Á½ɹæ/´ëµ¿¸Æ ....´ëµ¿¸ÆÈĺ®ÀÇ ¿òÁ÷ÀÓÀº Á½ɹæÀÇ Ã游/ºñ¿òÀ» ¹Ý¿µ ..... impaired LA emptying½Ã, ´ëµ¿¸ÆÈĺ®¿îµ¿ÀúÇÏ(during the rapid emptying phase, or the first third of diastole)...LA emptying index-.........If the first third of diastole does not represent at least 40% of the total amplitude of the aortic wall motion during diastole, then restriction to ventricular filling is suspected.

===LA emptying index: Decreased in c/o mitral stenosis Increased in c/o mitral regurgitation

8). Color doppler m-mode imaging ................Used to determine velocity of propagation (Vp) of LV inflow. ..........Determination of width of AR jet. .......... Duration of MR.

9)»ï÷ÆǸ·..... TAPSE (tricuspid annular plane systolic excursion)TV¿ÜÃøº®¿¡¼­ beamÀ» ÁÖ°í Mmode½ÃÇà½Ã ¿ì½É½Çº®ÀÇ ¼öÃàÀ̿Ͻà »óÇÏ¿òÁ÷ÀÓdeltaÀÇ Á¤µµ(15ÀÌÇÏ´Â ºñÁ¤»ó).......... a measure for assessing RV function ... TAPSE reference range 15 to 20mm .... Mildly abnormal- 13 to 15mm .... Moderately abnormal- 10 to 12mm .......Severely abnormal- <10mm

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@MS-SEVERITY :::: MVarea(cm^2)//meanGradient(mmHg)//PASP(mmHg) ::::: (mildMS) >1.5....<5.....pasp<30)..(modMS)  1-1.5.....5-10.....pasp30-50)..(severe.MS) <1....>10.....pasp>50) 

@AS-SEVERITY ::::  jetVelocity//MeanGradiwnt//AVA ::: (mildAS) jetV<3m/s...<25mmHg....AVA>1.5cm^2   :::(modAS) jetV3-4...25-40mmHg...1.0-1.5cm^2   :::(severeAS) jetV>4...40mmHg...<1.0cm^2

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@¿ì½É½Ç ¼öÃà±â´É=TAPSE:¿ì½É½Ç¿ÜÃøTVÆǸ··ûÀÇ ¼öÃà±â¿òÁ÷ÀÓ(  )(Á¤»ó>16). TV-TDI-s'(  )(Á¤»ó>10)

@ÁÂ½É½Ç À̿ϱâ´ÉÀå¾Ö......Grade0Á¤»ó (: wide, relat.highE > wide, relat.smallA : E/A>1)

//Grade1ÀÌ¿ÏÀå¾Ö(wide, lowE, incDT, +wide,high A : E/A<0.8)-2À§Á¤»ó(wide, highE +smallA : E/A>1)-3Á¦ÇѼºÀå¾Ö(wide, highE +smallA : E/A>>2(3)//Grade4(ºÒ°¡¿ªÀû Á¦ÇѼº Àå¾Ö..=¾ÐÃ༺½É³¶¿°..narrow,highE+smallA,E/A>>2(3)..¹ß»ì¹Ù·Îµµ ¿ª½Ã Grade3ÆÐÅÏ À¯Áö) 

(A4C...üũÇÊ¿ä : MVinflow/TDI, TRV, LAVI) 

[[½ÇÃøÄ¡]] ...MVinflow(E, A)-Á¤»ó/¹ß»ì¹Ù,  MVtdi-e'.a'(ann. LW) TRV , ÀÌ ¼¼°¡Áö´Â ¹Ýµå½Ã ÃøÁ¤ ÇÊ¿ä

---MVinflow(E)(   ), inflow(E/A)(  ) ---MVTDI(ann-e'/LW-e')(  /  ) ---E/e'(  ) 

--TRV(   ) ---LAVI(  )

***MVedv-TDI(mean)[ÆǸ··û:e'<7 or ¿ÜÃøº®:e'<10] ***Ratio of edvLVfilling=inflow- E/meanTDI-e' =E/e'>14, ***TRV>2.8, ***LAVI>34)

#Á½ɽDZ¸ÃàÀ²(º¯ÇüSimpson¹ý>60%)Á¤»ó½Ã [Á½ɽÇÀ̿ϱâ´ÉºÎÀü]ÆǺ°±âÁØ 4°¡Áö.......4Áß3°³ÀÌ»ó ÃæÁ·½Ã À̿ϱâ´ÉºÎÀü(..1°³ÀÌÇÏ ÃæÁ·½Ã Á¤»óÀ̿ϱâ´É, ±× »çÀÌ´Â À̿ϱâ´ÉºÎÀüºÒ¸íÈ®´Ü°è..

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#Á½ɽDZ¸ÃàÀ²(º¯ÇüSimpson¹ý>60%)ÀúÇϽà ½É±ÙÁúȯÀÚ 

....MVinflow E/A =0.8ÀÌÇÏ + E=50ÀÌÇÏ ---Á¤»óÁ½ɹæ¾Ð, 1´Ü°è À̿ϱâ´ÉÀå¾Ö(relaxAbn)--Áõ»óÀÌ ÀÖ´Ù¸é CAD, À̿ϱ⽺Ʈ·¹½º°Ë»ç °í·Á//....MVinflow E/A>2.0 --Á½ɹæ¾Ð »ó½Â, 3´Ü°è À̿ϱâ´ÉÀå¾Ö(restrictive)

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(¿¹½Ã)ÁÂ½É½Ç ¹ÚÃâ·ü 61%, Á½ɹæ ÃÖ´ë ¿ëÀûÁö¼ö 38.5 mL/m2, E 102 cm/s, E/A 1.79, DT 171 msec, septal e’ 6 cm/sec, lateral e’ 7 cm/sec, average E/e' 15.8, ÃÖ°í TR ¼Óµµ 2.84 m/sec 

---ÁÖÀÇ>>¸Å¿ì°Ç°­ÇÑ ÀþÀº ¿îµ¿¼±¼öµéÀÇ °æ¿ì MVinflow¿¡¼­ ÀüÇüÀûÀÎ grade4(ºñ°¡¿ªÀûÁ¦ÇѼº Àå¾Ö...narrow, high E, low A)ÆÐÅÏÀ» ³ªÅ¸³»±âµµ ÇÔ!!...ÀÌ°ÍÀ» superNormÀ̶ó ÇÔ!!(DDF°¡ ¾ø´Â Á¤»ó MVinflow¼Ò°ßÀº E/A>1À̸鼭 TDI¿¡¼­´Â ±×°ÍÀÇ °Å¿ï»óÀÌ ±×´ë·Î ³ª¿À´Â °Íó·³, superNorm¿¡¼­µµ ¿ª½Ã MVinflow¿¡¼­ ³ª¿Â superNormÇüÅ ±×´ë·ÎÀÇ °Å¿ï»óÀÌ TDI¿¡¼­ ³ª¿È(S3°¡ µé¸²..LAÁ¤»ó, PASPÁ¤»ó)

====================

@ÁÂ½É½Ç À̿ϱâ´É Æò°¡ ¾à½Ä¹ý : MVinflow(E, A). MVann-tdi(e', a')--------

              Grade0    Grade1(Relax.abn)  Grade2(peusoNorm)   Grade3(restrictive)  Grade4

MVinflow     E>A      E/A<0.8(inc.DT)     E/A>1(¹ß»ì¹ÙE/A<1)   E/A>>2(3)

MVann-TDI  e'>a'(°Å¿ï»ó) e'<=a'(°Å¿ï»ó)  ´õÀÛÀºe'<=´õÀÛÀºa'   ´õÀÛÀºe'<=´õÀÛÀºa'

ÁøÇà           <-½É±Ù¿°/CAD/HOCM-><-ÀÌ´¢Á¦/¼öºÐ°ú´Ù-> <-ÀÌ´¢Á¦/¼öºÐ°ú´Ù->

½ÉÀ½                     S4(peakA:LVÈıâÃ游Àå¾Ö)                   S3(LVÃ游Á¶±âÀå¾Ö)   S3

LAÅ©±â      Á¤»ó        Á¤»óorÈ®Àå             È®Àå(=RHF)              È®Àå                      

PASP        Á¤»ó        ´ë°³Á¤»ó               »ó½Â(=RHF)              »ó½Â

**highOutput(=normCO)Failure+diast.HF: LC. °©»ó¼±±â´ÉÇ×ÁøÁõ, ºóÇ÷, ÀÓ½Å,Beriberi

@ÁÂ½É½Ç À̿ϱâ´É Æò°¡ 4 ÁöÇ¥¿Í ºñÁ¤»ó °ª---------------------------------

1) ½Â¸ðÆÇ·û e’ °ª; Áß°ÝÃø(septal) e’<7 cm/sec, ¿ÜÃø(lateralWall) e’<10 cm/sec, 

2) Æò±Õ E/e’ °ª>14(Áß°ÝÃø E/e’>15, ¿Üº®Ãø E/e’>13), 

3) »ï÷ÆÇ¿ª·ù(tricuspid regurgitation, TR) ÃÖ°í¼Óµµ>2.8 m/sec

4) Á½ɹæ ÃÖ´ë ¿ëÀûÁö¼ö(volume index) > 34 mL/m2, 

----ÀÌÁß ¼¼ °¡Áö ÁöÇ¥ ÀÌ»óÀÌ Á¤»ó ¼öÄ¡¶ó¸é LVÀ̿ϱâ´É Á¤»ó, 

----¼¼ °¡Áö ÁöÇ¥ ÀÌ»óÀÌ ºñÁ¤»ó ¼öÄ¡¶ó¸é LVÀ̿ϱâ´É Àå¾Ö. 

----µÎ °¡Áö ÁöÇ¥¸¸ ºñÁ¤»ó ¼öÄ¡¿¡ ÇØ´çµÇ´Â °æ¿ì¿¡´Â °á·ÐÀ» ³»¸± ¼ö ¾ø´Ù

-----------------------

*Á½ɽÇÀ̿ϱ⿡¼­ ÃʱâÃ游Àº LV suction(relaxation)À¸·Î ÀÎÇÑ °ÍÀ̳ª, ÈıâÃ游Àº atrial kicking¿¡ ÀÇÇϸç LVEDP´Â LVcompliance(À¯¿¬¼º=°¡¼Ò¼º : ½ºÆ®·¹Äª´É·Â)¿¡ µû¶ó ´Þ¶óÁø´Ù.

*MVÁúȯ¾øÀÌ LA¸¸ È®ÀåµÇ´Â °æ¿ì´Â diast.DFÀÇ Á¸À縦 ½Ã»ç(¿øÀÎÁúº´ ãÀ¸¶ó!!)

*Æó°íÇ÷¾ÐÁõÀÇ °¡Àå ÈçÇÑ ¿øÀεéÀº LAP»ó½ÂÀ¸·Î ÀÎÇÑ °ÍÀ̸ç ÀÌ ¹üÁÖ´Â ´ë°³ MVD. syst.DF, diast.DF

===>À̿ϱâ½ÉºÎÀüDHFÄ¡·á : {üÁßÁ¶Àý::Á¦ÀÏÁß¿ä!!]--°íÇ÷¾Ð(ARB, ACEI, BBK, CCB, SPR) --Æó¿ïÇ÷(¼Ò±ÝÁ¦ÇÑ, ÀÌ´¢Á¦) --½É¹æ¼¼µ¿--CADÄ¡·á

========================

@@CMP

==HCMP : PLAX/Mmode-PSAX-A4C(±âÁØ)LVWTany>15, IVS/LVPW>1.3 (ºÎÀ§/ÇüÅÂ)Symm-concentric(Diffuse, Apical, midseptal), Asymm(BasalSeptal, totalSeptal, LatWall) .....MmodeSAM(À¯/¹«)---LVOTÇùÂø=¼öÃà±âÈıâ,´Ü°Ë»ó,ÈÄÃøº®MR>30(À¯/¹«)

==DCMP : inc.LVEDV-dec.EF(À¯/¹«)- LVRWMA(À¯/¹«), LVÀ̿ϱâÀå¾Ö(À¯/¹«), MR(À¯/¹«)--TR(À¯/¹«)--Phbp(À¯/¹«), LVthrombus(À¯/¹«)......ÁÖ»ê±â½É±Ùº´Áõ(Ãâ»ê1°³¿ùÀü~Ãâ»ê5°³¿ùÈÄ ±â°£)

==RCMP : Bilat.AE(À¯/¹«)--LVÀ̿ϱâÀå¾Ö(À¯/¹«)--Pul.edema(À¯/¹«)--RHF/Phbp(À¯/¹«)

==Stress-inducedCMP : ±¹¼Òº®(½É÷or Á߰ݺÎ) µÎ²²(ÀÌ»ó/Á¤»ó)//¿òÁ÷ÀÓ(ÀÌ»ó/Á¤»ó) --ST»ó½Â/inv.T(À¯/¹«)///½É½ÇºñÄ¡¹ÐÈ­Áõ///ºÎÁ¤¸ÆÀ¯¹ß¼º¿ì½É½Ç½É±Ùº´Áõ(RVE/trivTR+ RWMA-RV + RVaneurysm)

@@Æó°íÇ÷¾ÐÁõ......IVCÁ÷°æ°ú È£Èí½Ã º¯ÀÌ¿¡ µû¸¥ RAP¿¹ÃøÄ¡

-----RAP**[IVCÅ©±âÀÇ Èí±â½Ãº¯ÀÌ¿¡ µû¸¥ RAP¿¹ÃøÄ¡mmHg] 

>>IVC <2.5cm ((Èí±â½Ã50%À̻󰨼Ò=5//Èí±â½Ã50%ÀÌÇÏ°¨¼Ò=¿¹ÃøÄ¡10) ....>>.IVC>2.5(Èí±â½Ã50%ÀÌÇÏ °¨¼Ò=15....>>°£Á¤¸Æµµ È®Àå+Èí±â½ÃIVCº¯À̾øÀ½ =20

-----Pulhbp(ÆǴܱâÁØmmHg)eastimatedPASP=4*TRV^2 +RAP(¾ÈÁ¤½Ã>25, ¿îµ¿½Ã>30)

@@½É³¶»ïÃâ.....½É³¶¾ÐÁø(PLAX, PSAX, S4C.A4C)

***½É³¶»ïÃâ¾× ¾ç¿¡ µû¸¥ ºÐ·ù : 100CCÀÌ»óÀ϶§´Â ´ë°³ À̰ݰŸ®(mm)*25¹è¸¦ °öÇؼ­ Àú·ù¿ë·®À» ¿¹Ãø...À̰ݰŸ®°¡ 10mm(1cm)ÀÌ»óÀ̸é moderateÁß·®....Áß·®µî±ÞÀ̻󿡼­´Â ½ÉÀå¾ÐÁøµî ÇÕº´ÁõÀÌ Àß ¹ß»ýÇϹǷΠÁõ»ó¿¡ µû¶ó Áø´Ü/Ä¡·áÀû õÀÚ ÇÊ¿ä) 

 ::: Á¤»ó 20-50ml......½É³¶»ïÃâ°ú ´Á¸·»ïÃâÀÇ °¨º°Àº PLAXview¿¡¼­ ÇÏÇà´ëµ¿¸Æ¹Ù·Î »ó¹æÀ̸é PeriC,Eff.ÀÌ°í DAo ±ÙóÀÌ¸é ´Á¸·»ïÃâÀ̹ǷΠ°¨º°ÇÒ ¼ö ÀÖ´Ù..

( À§Ä¡Ç¥½Ã === PLAX-LVPW..15mm//Ap4c-LVatWall..12mm//SubC-RA..10mm )

1>¹Ì·®minimal/scantyl  ==¼öÃà±â¶§¸¸ ¶Ñ·Ç.. È®Àå±â¶§ ÀÌ°Ý °Å¸®´Â 5mmÀ̳» =50~100ml ; 

2>¼Ò·®mild/small == È®Àå±â¶§ ÀÌ°Ý °Å¸® 5-10mm = 100 ~ 250 mL

3>Áß·®moderate == È®Àå±â¶§ ÀÌ°Ý °Å¸® 10-20 mm  = 250  ~ 500 mL  

4>´ë·®large == È®Àå±â¶§ ÀÌ°Ý °Å¸® >20mm  = 500ml ÀÌ»ó

@@»ï³¶¾ÐÁø(subc4cView)...±Þ»ç¹ß»ý¿©ºÎ´Â ½É³¶»ïÃâ¾×Áõ°¡¼Óµµ°¡ °ü°Ç : Áø´Ü±âÁØ 1))¿ì½É½ÇÀÇ À̿ϱâ Àü¹Ý½ÃÁ¡ ÇãÅ», ¿ì½É¹æÀÇ À̿ϱâ ÈĹݽÃÁ¡ 1/3ÀÌ»óÀÇ invagination, 2))IVCÀÇ ³»°æÀÌ 2.5cmÀÌ»ó È®Àå + Èí±â½Ã Á¤»óÀû °¨¼Òº¯ÀÌ ¼Ò½Ç(=IVC plethora sign...¿ø·¡ subc4cView¿¡¼­ Èí±â½Ã IVCÁ÷°æ°¨¼Ò´Â 50%ÀÌ»óÀÌ Á¤»óÀÓ), 3))½Â¸ðÆÇinflow E velocityÈí±â-È£±âº¯ÀÌ>25%(È£±â½Ã Èí±â¶§º¸´Ù 25%ÀÌ»ó ÀúÇÏ) ¶Ç´Â Èí±â½Ã TRinflow E velocity°¡ 40%ÀÌ»óÁõ°¡

@@¾ÐÃ༺½É³¶¿° [JVP»ó½Â+¸»ÃʺÎÁ¾µîÀÇ ¿ì½ÉºÎÀüÁõ»óÀº Àִµ¥ ¿ì½ÉºÎÀü¼Ò°ßµé(RVA-RAE, IVSÁÂÇâÆíÀ§..TV-TDI¿¡¼­ ºñÁ¤»óTAPSE(Á¤»ó>16)¿Í ºñÁ¤»óS’¼Óµµ(Á¤»ó>10)´Â ¾ø´Â °æ¿ì¿¡ °¡Àå ¸ÕÀú ÀǽÉ...]--½É³¶<½ÉÀ帷>ºñ´ë>4mm +°£È¤ º¸ÀÌ´Â ¼®È¸È­(¸¸¼ºCP¿¡¼­ »ïÃâ¾×Àº ¾ø´Ù).....½ÉÃÊÀ½ÆÄ»ó À̿ϱâÃʱ⿡ ½É½ÇÀÌ ÁÂÃøÀ¸·Î ¹Ð¸®´Â Á߰ݵÇƦ(septal bouncing) +Á¤»ó¿ì½É¹æ/Á½ɽÇÀÌ ÀÖÀ¸¸é ½ÉÀå¾ÐÁø À¯¹ßÇÑ CPÀǽÉ..IVC Plethoraµµ ¾ç¼º..MVinflow E/A>1.5, Èí±â-È£±â½ÃEº¯ÀÌÆø>25%((¾ÆÁÖ ¶Ñ·Ç...Á¦ÇѼºCMP¿¡¼­´Â ÀÌ°ÍÀÌ Á¤»ó) DT<150À¸·Î ª¾ÆÁü---->Ann.e'>7-8 E/e'<15((Á¦ÇѼºCMP¿¡¼­´Â >15))

**{MV] 

B-bump(inc.LVEDP). flattenedEFS(MS). fluttering(Afib), holoSyst.hammock/lateSyst.tearDrop(MVPS). funnel-shapeMass(myxoma/Vegetation)

**[AV]: syst.multipleLinesDensity OR narrowing of AVopening(AS) eccentricAVClosureLine(bicusp).. NCCearlyDecresendoClosure(severeLVdysf) RCCearlyClosure(thickening) variableShapeOpening(LVADdysfunction)  flail AV-MV(Veg??)

mvAMLfluttering(chrAR-subaorticMemb)  AVnarrowDenseOpening(BE)+VearlyClosure(earlyF=VeryHighLVEDP)MV(acuteAR) SAM+AVmidsyst.notching(HOCM) 

**[LV]LVPWearlysyst.pre-contraction(WPW) RV-LV dilCMP  

insp.IVSshifToLV(pericared.eff./const.pericarditis) diast.RV collapse(Card.tamp)  paradox.septalMotion(op.)

**[RV]RVE +Paradox. septalMotion : ASD or PulmHBP 

**[PV]PS : shortDT+exaggerated deep indentation with prominent A(norm.indentation and atrial Kick) wave of diast.PV (PS) 

**PulmHBP : loss of PV diast. a wave + midsyst.notching(W-form)

**hypokineticApex...estimated EF=( LVED^2 - LVES^2)/LVED^2

--------------------------

@@TAPSE¿Í MAPSEÃøÁ¤Çϱâ : ¿òÁ÷ÀÓÀÌ °¡Àå ¶Ñ·ÇÇÏ°Ô º¸ÀÌ´Â ºÎºÐÀÇ ¿¬¼Ó¿îµ¿¼±»ó¿¡¼­ ÃøÁ¤Ç쵂 ÃÖÀúÁ¡°ú ÃÖ°íÁ¡À» ¸¶Å·ÇÑ ÈÄ ±× À̰ݰŸ®¸¦ ÃøÁ¤ÇÏ¸é µÊ...¿µ»óÀ» È®º¸ °íÁ¤½ÃŲ ÈÄ ¸¶Å·ÇÑ ´ÙÀ½ TAPSE, ¶Ç´Â MAPSE¸¦ ¼±ÅÃÇؼ­ D-E excursionÀ» ´­·¯¼­ ÃøÁ¤

#TAPSE (Á¤»ó>16mm): ÁßÁõÀÇ ¼öÃà±â½ÉºÎÀüÀÇ ´Ü±â-Àå±â ¿¹Èĸ¦ °áÁ¤ÇÏ´Â µ¶¸³Àû ¿¹Ãø¿ä¼Ò´Â °á±¹ RVdysfunction ¿©ºÎÀ̸ç, À̸¦ ÃøÁ¤ÇÏ´Â °£´ÜÇÑ ¹æ¹ýÀÌ TAPSEÀÓ....TAPSE´Â ½ÇÁ¦·Î´Â ¿ì½É½ÇÀÇ ÀåÃà¹æÇâ¿¡ À־ ½ÉÀåÁֱ⿡ µû¸¥ ±æÀÌ º¯È­[Áï, ¿ì½É÷ºÎ~¿ì½É½ÇTVann¿ÜÃøº®ÁöÁ¡°£°Å¸®ÀÇ  À̿ϱ⸻±æÀÌ-¼öÃà±â¸»±æÀÌÀÇ Â÷ÀÌ]À̸ç, TAPSE°¡ 15mmÀÌÇÏ·Î ÀúÇϵǴ °æ¿ì´Â RV dysfunction/strainÀÌ Á¸ÀçÇÔÀ» ¶æÇÔ=Bad prognosis), ¹°·Ð µ¿¹ÝµÇ´Â  COPDÁ¸Àç¿©ºÎµµ ¶Ç ´Ù¸¥ µ¶¸³ÀûÀÎ ¿¹ÈÄ°áÁ¤¿ä¼ÒÀÓ.....TAPSEÀÇ ÃøÁ¤Àº A4CView¿¡¼­ ½ÃÇàÇÏ°Ô µÇ´Âµ¥, IVSÀ» °¡»óÀÇ ¼öÁ÷beam°ú ÆòÇàÇÏ°Ô µÇµµ·Ï ¸¸µé¾î¼­ °¡´ÉÇÑÇÑ È­¸éÁß¾Ó¿¡ °¡±îÀÌ µÎ°í TVannulus¿ÜÃøº®ÀÇ »ïõÆÇ·ûÁ¢Á¡ºÎÀ§¿¡ Ä¿¼­¸¦ µÎ°í(È®´ë½ÃÄѼ­ Á¤È®ÇÑ ÁöÁ¡¿¡ Ä¿¼­¸¦ µÎ¶ó) M mode½ºÄµÀ» ½ÃÇàÇÏ¿© ¿ÜÃø³»º®¿òÁ÷ÀÓÀÇ ÃÖÀúÁ¡°ú ÃÖ°íÁ¡ ±× »çÀÌÀÇ ¼öÁ÷À̰ݰŸ®·Î °áÁ¤ÇÔ ----->Ambrisentan(º¼¸®ºê¸®½ºÁ¤5mg, 10mg)-Æó°íÇ÷¾ÐÄ¡·á

==¿ìÃø½ÉÀå±â´É Á¦´ë·Î º¸·Á¸é RV-RA Å©±â, RVÀÇ À̿ϱâ±â´ÉºÎÀü[diast.dysfunction](À» º¸´Â TVinflow, Tvlat.wallTDI(E/A <0.8 or>2.1, E/e'>6 DT<120msÀº ºñÁ¤»ó¼Ò°ßÀÓ), ÀÌ¿Í ÇÔ²²,  RVÀÇ ¼öÃà±â±â´ÉºÎÀü[syst.dysfunction]À» º¸´Â TAPSE, IVCÁ÷°æ(°£Á¤¸Æ±ÙÀ§ºÎ¿¡¼­ ÃøÁ¤), PVÀÇ M mode½ºÄµÀÌ ÇÊ¿äÇÔ..... IVCÁ÷°æÀÇ Å©±â°¡ Ä¿Á®ÀÖ°í(>2.1cm)¿Í Èí±â¿¡ µû¸¥ IVCÅ©±â°¨¼Ò°¡ 50%ÀÌÇÏÀÎ °æ¿ì´Â highRAP,=10~20mmHg(15) ¶Ç RAP¿Í µ¿¹ÝµÈ TRÁ¤µµ·Î PASP°¡ °áÁ¤µÊ(=4*TRV^2 +RAP), ÀÌ¿¡ ´õÇÏ¿© PV Mmode¼Ò°ßÀÇ º¯È­¿©ºÎ°¡ Áß¿äÇѵ¥..PVÀÇ M mode´Â E-F, a-dip, b bounce, c decrement, d syst.enpoint·Î ±¸¼ºµÇ¸ç..... PS¶§¿¡´Â a-dipÀÌ ±í¾îÁö°í, pulm-HBP(PASP>25mmHg)¶§¿¡´Â loss of a-dip, d-e»çÀÌ¿¡ notch°¡ ¹ß»ýÇÏ¿© flying WÆÐÅÏÀÌ ³ªÅ¸³² 

#MAPSE(Á¤»ó 12-15mm...¿ÜÃøº®¼öÄ¡°¡ Á߰ݺ®¼öÄ¡º¸´Ù ÀϹÝÀûÀ¸·Î ³ô°Ô ³ª¿È)...MAPSE´Â ±âÀú¼±ºÎÅÍ post-systolic motionÀÌ ³ª¿À±âÁ÷ÀüÀÇ ³ôÀ̱îÁö ÃøÁ¤ÇÔ) : ÀÏ°ß º¸±â¿¡ EFÀÌ Á¤»óÀÎ °íÇ÷¾Ð µîÀ» Á¤¹ÐºÐ¼®, Á» ´õ ¼¼¹ÐÇÏ°Ô LVsyst.DysfunctionÀ» ³ªÅ¸³»´Â ¿ä¼ÒÀÓ.....meanMAPSE 10mmÀÌ»óÀ̸é real EF=55%ÀÌ»ó, MAPSE 8mmÀÌÇϸé EFÀÇ ½ÇÁ¦¼öÄ¡´Â 50%ÀÌÇÏ....Æí±ÕMAPSE°¡ 7mmÀÌ¸é ½ÇÁ¦ EFÀº ¹«·Á30%±îÁö Ç϶ôÇÔ...ÃøÁ¤¹ýÀº TAPSE¿¡¼­¿Í µ¿ÀÏÇѵ¥ ´Ù¸¸ Ä¿¼­¸¦ MV annulusÀÇ septum¿¡ µÎ°í M mode½ºÄµÀ» ½ÃÇàÇÔ-------½ÉºÎÀü, ½É¹æ¼¼µ¿,PMI, severeAS (AVR½ÃÇàÇÑ)ÀÇ ÇâÈÄ ¿¹ÈÄ°¡ ºÒ·®ÇÒ °ÍÀ» ÀǹÌ

 MAPSE´Â Á½ɽDZâ´É, ƯÈ÷ ÀåÃà¼öÃà·ÂÀÌ ¾î¶²Áö¸¦ º¸´Â Áß¿äÇÑ º¯¼ö(parameter)·Î¼­ Á½ɽDZ¸Ãâ·üejection fraction (EF....ÀÌ´Â ÀåÃà»ó°ú ¿øÁÖ»ó ½É±Ù¼¶À¯ÀÇ ¼öÃà±â´ÉÀÇ ÇÕÀÛÀÓ)¿¡ ´ëÇØ »óº¸ÀûÀÎ Á¤º¸¸¦ Á¦°øÇÑ´Ù. endo- (and potentially epi-) cardial ischaemia, fibrosis, or increased wall stress·Î ÀÎÇؼ­ ¾ß±âµÇ´Â ÀåÃà½É±Ù¼¶À¯ÀÇ ±â´ÉÀÌ»ó ¶Ç´Â ½ºÆ®·¹½º¿©ºÎ¸¦ ¾Ë¼ö ÀÖ°Ô µÊ... ASȯÀÚ¿¡°Ô À־ MAPSE°¨¼Ò°¡ º¸ÀÌ´Â °æ¿ì subendocardial fibrosis¸¦ ½Ã»çÇϸç ƯÈ÷ EF°¡ Á¤»óÀÎ °íÇ÷¾ÐȯÀÚ¿¡°Ô¼­ MAPSE°¨¼Ò°¡ º¸Àδٸé LV±â´ÉºÎÀüÀÌ ¿Ã °ÍÀ» ½Ã»çÇÏ´Â ¹Î°¨µµ°¡ ³ôÀº Á¶±â¸¶Ä¿·Î »ç¿ëÇÒ ¼ö Àִµ¥, ÀÌ °æ¿ì ÀåÃà±â´ÉÀÌ»óÀº ÈçÈ÷ º¸»óÀûÀ¸·Î ³ªÅ¸³ª´Â ¿øÁÖ»ó(circumferential) ¼¶À¯ÀÇ ±â´ÉÀÌ»ó¿¡ ÀÇÇØ °¡·ÁÁö°Ô µÇ±â¶§¹®. 

**¹°·Ð MAPSE¿Í EF°£ÀÇ ¿¹ÃøÀÎÀڷμ­ÀÇ »ó°ü°ü°è´Â Á¤»ó ¶Ç´Â È®ÀåµÈ LVÀÏ ¶§ Àû¿ëÇÔ µÊ...Áï, concentric hypertrophyȯÀÚÀÎ °æ¿ì´Â EF ¹× FSÀÌ Á¤»óÀÌ¶óµµ MAPSE°¨¼Ò°¡ ÀÌ¹Ì ¹ß»ýÇØ Àֱ⠶§¹®(ÀåÃà½É±Ù¼¶À¯´Â ±â´ÉÀÌ»óÀÌ ÀÌ¹Ì ¿Í ÀÖÀ¸³ª ¿øÇü½É±Ù¼¶À¯±â´ÉÀº º¸Á¸µÇ°Å³ª ¿ÀÈ÷·Á Áõ°¡µÇ¾î ÀÖÀ½). °Ô´Ù°¡ ³ªÀÌ°¡ µé¼ö·Ï MAPSE´Â °¨¼ÒÇÏÁö¸¸, EFÀº º¯ÇÔ¾ø°Å³ª ¿ÀÈ÷·Á Áõ°¡µÇ´Â °æÇâÀÌ Àֱ⠶§¹®. **°Ô´Ù°¡ ƯÈ÷ ½ÉºÎÀüÀÌ ÀÖÀ¸³ª preserved LVEFÀ» º¸À̴ ȯÀÚ¿¡°Ô¼­ È޽ĽÃ/¿îµ¿½Ã MV-TDIÀÇ ¼öÃà¼ÓµµSmÀº MAPSE¿Í ¾ÆÁÖ ±íÀº »ó°ü¼ºÀ» ³ªÅ¸³»°í ÀÖÀ½ **MAPSE´Â LV strain¶§ °¨¼ÒÇÏ°Ô µÊ(½É±Ù¼¶À¯ strainÁ¾·ù¿¡´Â  ÀåÃà»ólongitudinal, ¿øÇü»óradial, ¿øÁÖ»ócircumferentialÀÌ ÀÖÀ½)

==HHD(Á½ɽDZâ´ÉºÎÀüÀÇ Á¶±âÁöÇ¥·Î »ç¿ë), 

==CAD(RWMA°¡ Á¤»óÀÌ¶óµµ ½É³»¸·ÇÏ ±â´ÉºÎÀüÁ¸À縦 ½Ã»ç), 

==chr.HF : DCMP³ª MI¿¡ ¼Ó¹ßµÈ ¸¸¼º½ÉºÎÀü¿¡¼­´Â MAPSE°¡ Å©°Ô °¨¼ÒÇÏ°Ô µÇ´Â¤§[ ÀÌ´Â EF¿ÍÀÇ »ó°ü¼ºÀÌ ¸Å¿ì Å©°Ô ³ªÅ¸³².... »Ó¸¸¾Æ´Ï¶ó EFÀÌ Á¤»óÀÎ ½ÉºÎÀüȯÀÚ¸¦ Áø´ÜÇϴµ¥ À־µµ, ƯÈ÷ ¿îµ¿½Ã MAPSE´Â ¸Å¿ì À¯¿ëÇϸ鼭µµ ½¬¿î ÃøÁ¤µµ±¸ÀÓÀÌ ÀÔÁõµÊ

==symptomatic AS(LVEFº¸´Ù ´õ ¿¹¹ÎÇÑ Á¶±âÁöÇ¥À̸鼭 µ¶¸³Àû ¿¹ÃøÀÎÀÚ..7mmÀÌ»óÀ̸é AVR¿¹ÈÄ°¡ ÁÁ´Ù...¶ÇÇÑ °°Àº low gradeÀ̱⠶§¹®¿¡ °¨º°ÀÌ Èûµç severeAS¿Í mod.AS°¨º°µµ °¡´ÉÄÉ µÇ¾ú´Âµ¥ MAPSE<9mmÀÇ ÄÆ¿ÀÇÁ¼öÄ¡¸¦ Àû¿ëÇßÀ» ¶§ ¹Î°¨µµ.ƯÀ̵µ ¸ðµÎ 100%¿´À½..

[[LV dysfunctionÄ¡·á]]

==ACE ¾ïÁ¦Á¦ << ARB(Ä­µ¥»ìźqD 32mg±îÁö Áõ·®, ¹ß»ìź Bid 160mg±îÁö Áõ·®, ·Î»ìź qD 250mg±îÁö Áõ·®)......

==º£Å¸ Â÷´ÜÁ¦( bisoprolol qD 10mg±îÁö Áõ·®, sustained-release metoprolol (succinate) qD, 200mg±îÁö Áõ·®, cavedilol Bid 20-50mg±îÁö Áõ·® , nebivolol qD 10mg±îÁö Áõ·®.. µî 4°¡Áö ¾àÁ¦¸¸ÀÌ ¹ÚÃà·ü ÀúÇÏ ½ÉºÎÀü¿¡¼­ ¿¹ÈÄ °³¼± È¿°ú¸¦ ÀÔÁõ.»ç¿ë°¡´É//.....

==Aldosterone ±æÇ×Á¦....Ivabradine(( ACE ¾ïÁ¦Á¦/ARB, º£Å¸ Â÷´ÜÁ¦ ¹× mineralocorticoid receptor ±æÇ×Á¦(eplerenone/spironolactone) 3Á¦ ¿ä¹ýÀ» »ç¿ëÇßÀ½¿¡µµ ºÒ±¸ÇÏ°í (i) ½ÉºÎÀü Áõ»óÀÌ Áö¼ÓµÇ¸é¼­ (ii) left ventricular ejection fractionÀÌ 35% ÀÌÇÏÀÌ°í (iii)Á¤»ó µ¿À²µ¿À̸鼭 (iv) ½É¹Ú¼ö°¡ 70 bpmÀ» ÃÊ°úÇϴ ȯÀÚ¿¡°Ô´Â ivabradineÀ» Ãß°¡ÇÏ´Â °ÍÀ» ±Ç°í

==µð°î½Å  ......Á¤»ó µ¿·üµ¿À̸鼭 ACE ¾ïÁ¦Á¦ µî ´Ù¸¥ ¾àÁ¦ÀÇ Åõ¿©¿¡µµ ºÒ±¸ÇÏ°í ½ÉºÎÀüÁõÀÌ Áö¼ÓµÇ°Å³ª ½É¹æ ¼¼µ¿ÀÌ µ¿¹ÝµÇ¾î ¸Æ¹Ú¼ö¸¦ Á¶ÀýÇϱâ À§ÇØ Åõ¿©ÇÒ ¼ö ÀÖ´Ù. ÀϹÝÀûÀÎ À¯Áö Åõ¿© ¿ë·®Àº 0.125 mg/day¸¦ ±ÇÀå.

----------------------------

@@ÀåÃà½É½Ç±â´ÉÀÇ Á¤·®Àû ÃøÁ¤ :: ¹æ½ÇÁ¢ÇպΠ¿îµ¿Æø(MVPSE, TAPSE), Á¶Á÷µµÇ÷¯À̹Ì¡±â¹ýTDIÀ¸·Î ÃøÁ¤ÇÑ µ¿ÀϺÎÀ§ÀÇ ¼öÃà±â¼Óµµ, À̵é°ú ½É½Çstrain/strain rate·Î º» ÀåÃàÇüżջóÁ¤µµ´Â »óÈ£¿¬°ü¼ºÀ» °¡Áö°í ³ªÅ¸³²....¹°·Ð ¾Æ·¡¿¡ Á¦½ÃµÈ °ªµéÀº LV¿Í RVÀÇ ÀåÃà±â´ÉÀÇ ÇÏÇѼ±À» Á¦½ÃÇÏ°í´Â ÀÖÁö¸¸ È®Á¤µÈ Àü¼¼°èÀûÀÎ ±âÁØÀº ¾ÆÁ÷ ¾ø´Ù....ÀÌ ¼öÄ¡µé¿¡ °ü¿©ÇÏ´Â ¿ä¼ÒµéÀº Àû¾îµµ 4°³Á¤µµ¸¦ °í·ÁÇϴµ¥, ³ªÀÌ, M mode¹× TDIÃøÁ¤½Ã °Ë»çbeamÀÇ angulation, È£Èí°ú ¼±ÅÃÇÑ °Ë»ç¼ö´Ü µîÀÌ ±×°ÍÀÌ´Ù. ................. Cardiac function and PA pressure¿¡¼­ ¹ßÃé

--¸ðµÎ ¿ÜÃøº®Á¢Çպο¡¼­ ÃøÁ¤ÇßÀ½(MVÁ߰ݺ®ÃøÀº MV¿ÜÃøº®¿¡¼­ º¸´Ù ³·´Ù)---

 MAPSE (mitral annular plane systolic excursion)   1 cm 

 MASV (mitral annular systolic velocity) =MV-Sm  10 cm/s 

 LV-LSS (left venticular longitudinal systolic strain)   – 20 % 

-----------------------------------------------------------

 TAPSE (tricuspid annular plane systolic excursion)   2 cm

 TASV (tricuspid annular systolic velocity) =TV-Sm  20 cm/s 

 RV-LSS (right ventricular longitudinal systolic strain)   – 30 % 

..............................................................................................................

TV-TDI ::: sm<11.5cm/s((RVEF<45%...RV¼öÃàÀå¾Ö))  e'6.5((=¿¹Èĺҷ®)) 

TAPSE(15-20)<15(2³â³» 45%»ç¸Á...¼öÃàÀå¾Ö)  RVA/LVA>1

----------------------

@@LV ¼öÃà±â´ÉÁöÇ¥

==linear method : M mode¸¦ ÀÌ¿ë...RWMAÀÌ»ó½Ã¿¡´Â ÀüÇô ¾µ¸ð¾øÀ½

¢ººÐȹ´ÜÃà·ü Fractional shortening (FS) ::: Normal >30% (25-45%)...• Severe LV dysfunction <15%

¢º Mitral E point septal separation (EPSS) :: Á¤»óÀº <5, 7ÀÌ»ó½Ã´Â EF30%ÀÌÇÏ·Î °¨¼Ò

¢º Á½ɽDZ¸Ç÷·ü Ejection fraction (EF)  ::: M mode¹ýº¸´Ù´Â Modified Simpson¹ýÀ»!!

¢º ÀÏȸ¹ÚÃâ·®/½É¹ÚÃâ·® Stroke volume / cardiac output(3Â÷¿ø ÃÊÀ½ÆÄ)

¢º Ejection acceleration time in LVOT(LVOT ACC)Á¤»óÀº 8-14.....A3C¿¡¼­ LVOT, AV¿¡¼­ 1cm¿øÀ§ºÎ¿¡ »ùÇú¼·ý µÎ°í PW·Î ¾òÀ½

¢º dP/dtmax-MV(A4C, MV¿¡¼­ ½ÃÇàCW-MRjet·ÎºÎÅÍ ¾òÀ½...1m/sec¿¡¼­ 3m/sec¿¡µµ´ÞÇϱâ±îÁöÀÇ ÃÊ´ç¾Ð·Â...Á¤»ó > 1,200 mmHg/sec....• ÁßÁõ ¼öÃà±â´É ÀúÇÏ< 800 mmHg/sec ÀÌÇÏ

¢º Mitral annular systolic wave (Sm) by TDI    ::: MVsetum-TDI¿¡¼­ Sm>7.5cm/sÀ̸é LVEF>50%(¹Î°¨µµ79% ƯÀ̵µ88%)

¢º Tei index (Index of myocardial performance, IMP) ::¼öÃà±â+À̿ϱ⠱â´ÉÀÌ»óÀ» ÇÔ²² °í·Á

¢º LV global longitudinal Strain

================

FS(M-mode) EPSS ==>mitral-dP/dt....===>MVseptum-TDI ::.Tei index....add>Sm


[[LVÀ̿ϱâ/¼öÃà±â ±â´ÉºÎÀü, RVÀ̿ϱâ/¼öÃà±â ±â´ÉºÎÀü]] TDI/MmodeÁöÇ¥µé

**LVDD(LVÀ̿ϱâ´ÉºÎÀü) : MV-TDI e'

**LVSD(LV¼öÃà±â´ÉºÎÀü) : s'<7.5, TDI-MPI<0.39, MAPSE<12

**RVDD(RVÀ̿ϱâ´ÉºÎÀü) : TV-TDI e' (flat, IVS dyskinesia + RVEDA>LVEDA´Â ÀÌ¹Ì RVSD¼öÃà±âºÎÀü!!)

**RVSD(RV¼öÃà±â´ÉºÎÀü) : s'<10 , TDI-MPI<0.54 TAPSE<17..........PulmHBP[.dil.IVC>2.1cm + respVariation(-).. TR>2.8]?? .........PV stenosis[ PV Mmode : flying W sign]??.......Peric.Eff/Card.Tampon[freeSpace + RV/RA diast.invagination]??..

´ÙÀ½±Û : ¸¶½ºÅ© Åë°î¹° À̿ϱâÀå¾Ö IV Áß±¹
ÀÌÀü±Û : RWMA ³úavm ±Þ¼ºÆó»öÀü LVDDf