Dr. Usman's Cardiology Notes

  Myocardial Performance Index (MPI) by Tissue Doppler Imaging (TDI): An Echo Practical Guide The Myocardial Performance Index (MPI) , also known as the Tei index , is a Doppler-derived echocardiographic parameter used to assess global ventricular performance by combining systolic and diastolic time intervals. It provides additional information about myocardial function beyond conventional measures such as left ventricular ejection fraction (LVEF). With tissue Doppler imaging (TDI) , MPI can be calculated using myocardial velocity waveforms recorded at the mitral or tricuspid annulus. This practical guide explains the formula, measurement technique, interpretation, and important clinical considerations for echocardiographers, cardiologists, and medical trainees. Key Point MPI = (Isovolumic Contraction Time + Isovolumic Relaxation Time) ÷ Ejection Time. 1. What Is the Myocardial Performance Index? The Myocardial Performance Index is a dimensionless ratio that com...

Mitral Valve Area by Pressure Half-Time (PHT): Formula, Measurement, and Clinical Interpretation Accurate assessment of mitral stenosis is an essential part of echocardiography. Among the Doppler techniques available, the pressure half-time (PHT) method provides a convenient way to estimate mitral valve area (MVA) and assess the severity of mitral stenosis. This technique is widely used in routine transthoracic echocardiography because it requires a continuous-wave Doppler recording of transmitral flow and a straightforward calculation. However, PHT is influenced by cardiac haemodynamics and chamber compliance, meaning that its results must be interpreted alongside other echocardiographic findings. In this guide, we will discuss the definition of pressure half-time, the correct formula for calculating mitral valve area, the step-by-step measurement technique, severity assessment, clinical applications, and common mistakes to avoid during echocardiography. Key Clinical Formu...

How to Measure Pulmonary Blood Flow (Qp) by Echocardiography: Step-by-Step Guide Pulmonary blood flow (Qp) is an important echocardiographic parameter used to assess blood flow through the pulmonary circulation. It is particularly useful in evaluating congenital heart disease, intracardiac shunts, and conditions associated with abnormal pulmonary blood flow. In Doppler echocardiography, pulmonary stroke volume can be calculated by multiplying the cross-sectional area of the pulmonary valve annulus by the velocity-time integral (VTI) of blood flow in the right ventricular outflow tract (RVOT). Key Formula Pulmonary Stroke Volume (Qp per beat) = Pulmonary Valve Annular Area × Pulmonary VTI Qp = π × (D/2)² × VTI D = Pulmonary valve annulus diameter VTI = Velocity-time integral in cm Result = Stroke volume in mL/beat 1. Measure the Pulmonary Valve Annulus Diameter The first step is to measure the diameter of the pulmonary valve annulus. Because the diameter is squared whe...

  Measurement of Right Ventricular Function: TAPSE on Echocardiography Tricuspid Annular Plane Systolic Excursion (TAPSE) is a simple, reproducible echocardiographic measurement used to assess right ventricular (RV) systolic function. It measures the longitudinal movement of the lateral tricuspid annulus toward the cardiac apex during systole. TAPSE is widely used because it is easy to obtain, requires minimal calculation, and is available on most echocardiography systems. What Is TAPSE? TAPSE reflects the longitudinal contraction of the right ventricle. During systole, the lateral tricuspid annulus moves toward the apex. M-mode echocardiography records this movement, allowing the distance travelled by the annulus to be measured in millimetres. Although TAPSE is a useful marker of RV systolic function, it primarily assesses longitudinal motion and should not be used as the sole measure of right ventricular performance. Normal TAPSE Value Normal TAPSE: >17 mm A T...

RV Enlargement on Echocardiography: ASE 2025 Grading, Causes and Clinical Interpretation Right ventricular enlargement is an important echocardiographic finding that may reflect pressure overload, volume overload or intrinsic myocardial disease. However, RV dilatation is not a diagnosis by itself, and its significance depends on the underlying clinical condition and associated echocardiographic abnormalities. In Part 1, we reviewed the updated 2025 American Society of Echocardiography (ASE) normal reference values and measurement techniques for RV basal, mid-ventricular and longitudinal dimensions. In this second part, we discuss the grading of RV enlargement, its clinical interpretation, associated echocardiographic parameters, common measurement errors and practical reporting. 1. What Is Right Ventricular Enlargement? Right ventricular enlargement refers to an increase in RV cavity dimensions beyond the expected reference range. It may involve the basal region, mid-ventricu...

  Cardiac Resynchronization Therapy (CRT): Indications, Guidelines and Clinical Decision-Making A practical, guideline-based guide for cardiologists, electrophysiologists, postgraduate trainees and medical students. Introduction Cardiac resynchronization therapy (CRT) is a device-based treatment for selected patients with heart failure and ventricular electrical dyssynchrony. By coordinating right and left ventricular activation, CRT can improve left ventricular systolic function, reduce heart failure hospitalizations, improve functional status and, in appropriately selected patients, reduce mortality. Patient selection is critical. The greatest benefit is generally observed in patients with heart failure with reduced ejection fraction (HFrEF), left bundle branch block (LBBB), and a markedly prolonged QRS duration. Key clinical message The classic CRT candidate has LVEF ≤35%, persistent symptoms despite guideline-directed medical therapy (GDMT), sinus rhythm, LBBB mo...

2026 ESC Heart Failure Guidelines: Classification, Diagnosis and Treatment A practical clinical review for cardiologists, physicians, postgraduate trainees and medical students. Introduction The 2026 European Society of Cardiology (ESC) Guidelines for the Management of Heart Failure introduce important changes in the classification, prevention, diagnosis and treatment of heart failure (HF). Published on 28 August 2026, these guidelines update the previous ESC recommendations and emphasize early diagnosis, prevention of disease progression and individualized treatment. The major changes include a simplified classification based on left ventricular ejection fraction (LVEF), adoption of HF stages A–D, revised terminology for medical therapies and updated recommendations for pharmacological and device-based treatment. Key update: The 2026 ESC guidelines eliminate the separate HFmrEF category. HFrEF is defined by LVEF below 50%, whereas HFpEF is defined by LVEF of 50% or higher,...