1. Cath. Data

9. Dilated Cardiomyopathy

10. I. Overview Definition : Dilatation and impaired contraction of LV or both LV and RV m/c cardiomyopathy Cause : idiopathic, ischemia, virus, inherited, alcohol, pregnancy, thyroid disease, drug, etc Diagnosis : Echocardiography

11. II. Echocardiographic findings -LV size & volume, LV EF, MR, PASP, RV function, Diastolic function ① Dilated LV (spherical geometry), decreased LV systolic function ② Diastolic dysfunction, MR, TR, increased LA pr. Pulmonary HTN, thrombus formation, spontaneous echo contrast ② M- mode : MV(EPSS > 6mm), AV( 사각형 -> 원형 ) ③ Doppler : 수축기능 평가 (TVI, S≤ 7.5cm/s, dP/dT), 이완기능 평가 (mitral inflow pattern, pulmonary vein flow, annular doppler tissue imagine), Myocardial perfomance index(MPI IVRT + IVST/ 수축시 간 N ≤0.4)

12. II. Echocardiographic predictors of adverse prognosis -LV size and function LV internal dimension LVEDV > 75 mL/m 2 LVESV >55 mL/m 2 LVEF < 40% Sphericity index <1.5 LV ventricular dP/dT <600 mmHg/sec Myocardial performance index > 0.4 -Diastolic properties of the LV Restrictive mitral inflow pattern Pseudonormal mitral inflow pattern

13. Rt. Heart Failure with severe TR

14. I. Rt. heart failure Cause -chronic lung condition -airway disease -pulmonary HTN -heart valve disease -congenital heart defect

15. II. Evaluation of TR severity ParameterMildModerateSevere TVnormalNormal or abnormal Abnormal/Fail leaflet/Poor coaptation RV/RA/IVC size NormalNormal or dilateddilated Jet area- central jets(cm2) <55~10>10 VC width (cm)Not defined <0.7>0.7 PISA radius (cm) ≤ 0.50.6~0.9>0.9 CWSoft & parabolicDense, variableDense, triangular with early peaking Hepatic vein flow Systolic dominance Systolic bluntingSystolic reversal

16. I. Management of TR Class I 1. TV repair is beneficial for severe TR in pts with MV disease requiring MV surgery(B) Class IIa 1.TVR or annuloplasty is reasonable for severe primary TR when symptomatic(C) 2.TVR is reasonable for severe TR secondary to diseased/abnormal TV leaflets not amenable to annuloplasty or repair(C) Class IIb 1.TV annuloplasty may be considered for less than severe TR in pts undergoing MV surgery when there is pulmonary HTN or TV annular dilatation(C) Class III 1.TVR or annuloplasty is not indicated in asymptomatic pts with TR whose PASP is less than 60mmHg in the presence of a normal MV 2.TVR or annuloplasty is not indicated in pts with mild primary TR 2008 ACC/AHA Guideline