SONO

• ECHO: https://youtu.be/1E4NSR6yjMw
• Echo Reporting Guidelines: https://www.asecho.org/guideline/guidelines-for-the-standardization-of-adult-echocardiography-reporting/

Consensus Panel Gray-Scale and Doppler US Criteria for Diagnosis of ICA Stenosis, doi 10.1148/radiol.2292030516

• Plaque estimate (diameter reduction) with gray-scale and color Doppler US.

Školoudík Tab. 4.1. TCD – fyziologické průtoky a hloubky insonace základních mozkových tepen:

Normální hodnoty Školoudík Příloha 4 (vždy hodnota ± SD, tedy pro 2 SD nutno přepočítat):

• Snížená: vymizení reakce na hyperkapnii
• Vyčerpaná: absence změn při hyperkapnii i při hypokapnii
• Paradoxní: opačná změna průtoku (snížení při hyperkapnii a zvýšení při hypokapnii), vnitřní steal mezi povodími

• 10 vteřin zadržení dechu
• 30–40 vteřin hyperventilace
• Vmean sníží o alespoň 15–20 %

• Nejprve normální dýchání a potom zadržení dechu (bez Valsalva!!!)
• Zadržení dechu po nejdelší možnou dobu, které je schopen
• Dle některých prací stačí 30 vteřin (10.1212/WNL.0000000000006822)

  BHI = ( ( (Vmean_test - Vmean_baseline)/ Vmean_baseline ) * 100 ) / time
  

• Zopakovat 3krát!!!
• Pro tepny karotického povodí 1,2 ± 0,6
• Pro riziko iktu chceme BHI > 0.69 (doi 10.1111/j.1552-6569.2010.00523.x)
• Pro kognici chceme BHI > 0.89 (doi 10.1212/WNL.0000000000004862)

• Urychlení (viz níže)
• turbulentní tok
• aliasing
• zúžení v power mode
• hyperechogenní plát v B-modu
• Continuity equation:

  Percent Stenosis = (1 - PSV_prestenontic / PSV_intrastenotic ) * 100 %
  

  PSV_stenoza / PSV_mimo	Tíže stenózy
  1,3–1,99	lehká
  2,0–2,99	středně těžká
  >3	těžká (>60 %)

• https://youtu.be/vcwO8g4-58M?si=gRsaTeZiHaGM9Ywf
• https://radiopaedia.org/articles/giant-cell-arteritis
• https://www.cureus.com/articles/165269-temporal-artery-ultrasound-for-the-diagnosis-of-giant-cell-arteritis-in-the-emergency-department#!/
• U temporomandibulárního kloubu kmen arteria, prochází skrz glandula parotis, 11 MHz
• Nad ramus zygomaticus je bifurkace na ramus frontalis a ramus parietalis, vysokofrekvenční sonda
• Colour PRF ~ 9 cm/s, wall filter low, colour gain 40–55
• (ramus auricularis posterior, ramus occipitalis)
• halo
• nelze komprimovat
• zesílení stěny:

  tepna	IMT (mm)
  arteria temporalis superficialis	0.42
  ramus frontalis	0.34
  ramus parietalis	0.29
  arteria facialis	0.29
  arteria axillaris	1.00

RWT (relative wall thickness) = 2x PWd/LVEDD, norma 22–42 %

Odhad tlaku v pravé síni (validní jen u klidné spontánní ventilace):

• Měření v místě největší separace v diastole

  Malý	do 5 mm (50 ml)
  Střední	5–20 mm (50–500 ml)
  Velký	nad 20 mm (nad 500 ml)

• kissing papillaries

Transmitral flow deceleration time (DT) reflects the rate of decline in the left atrial-to-left ventricular pressure gradient after mitral valve opening, and changes in DT indicate alterations in LV compliance, LV relaxation, and left atrial pressure (LAP). The pathophysiological significance depends on whether DT is shortened or prolonged, and must be interpreted in the context of other diastolic parameters.

Shortened DT (<150 ms): A shortened DT indicates reduced LV diastolic compliance and typically occurs when elevated LAP causes rapid equilibration of left atrial and ventricular pressures during early diastole. The rate at which the E-wave velocity decreases is inversely proportional to the net compliance of the LA and LV—thus, the stiffer the ventricle, the shorter the DT. [1] When combined with a tall E-wave and high E/A ratio (restrictive filling pattern), a DT <150 ms signifies grade III diastolic dysfunction with markedly elevated filling pressures and is associated with adverse prognosis in various disease states.

However, shortened DT is not always pathological. Young healthy individuals with high mitral E velocities may have DT <150 ms as a normal variant. Therefore, shortened DT should not be used as a stand-alone index of reduced LV compliance.

Prolonged DT: Prolonged DT occurs in impaired relaxation (grade I diastolic dysfunction), where slowed LV relaxation causes ongoing pressure decline during flow deceleration. This pattern is characterized by reduced E velocity, increased A velocity (E/A <0.8), and normal or low LAP. [3-4] The relationship between DT and diastolic dysfunction is nonlinear—in mild dysfunction dominated by impaired relaxation, DT is prolonged rather than shortened.

Pseudonormalization: With disease progression, compensatory elevation of LAP can "normalize" both DT and E/A ratio despite persistent relaxation abnormalities (grade II or pseudonormal pattern). This represents a fundamental challenge in diastolic assessment, as the filling pattern appears deceptively normal. Valsalva maneuver or tissue Doppler (reduced e′) can help distinguish pseudonormal from truly normal patterns.

DT is influenced by the rate of decline in the LA-LV pressure gradient and therefore reflects both LV relaxation and LV stiffness. It must be interpreted alongside E/A ratio, E/e′, LA volume index, and TR velocity for accurate assessment of diastolic function and filling pressures. Heart rate, conduction abnormalities (AV block, LBBB), and tachycardia can cause E-A fusion and ambiguity in interpretation.

Start with Mitral Inflow (E/A, DecT)

• E/A ≤ 0.8 and DecT > 200 ms → impaired relaxation, normal LAP
• E/A ≤ 0.8 and DecT < 200 ms → impaired relaxation, ↑ LAP
• E/A 0.8–2.0 → go to Step 2
• E/A ≥ 2.0 → restrictive filling, ↑ LAP

Evaluate 3 Supportive Parameters (when E/A is 0.8–2.0 or unclear)

• Average E/e′ > 14 → ↑ LAP
• LAVi > 34 mL/m² → chronic ↑ LAP
• TR velocity > 2.8 m/s → pulmonary pressure elevation

Integrate

• ≥3 abnormal → LV filling pressures ↑
• 0–1 abnormal → LV filling pressures normal
• 2 abnormal → indeterminate → weigh clinical context (age, LA size, BNP, comorbidities)

Extra bedside clues

• Very large LA → chronically ↑ filling pressure even if other parameters are equivocal
• Short DecT (< 160 ms) → often signals high LVEDP
• BNP/NT-proBNP → useful to support echo findings
• Rhythm: AF makes E/A less reliable, but LA size + BNP still helpful

• Úspěšný weaning je možné predikovat v režimu PSV, flow trigger 2 l/min. při tloušŤce v inspiriu > 1.8 mm, DTf > 30 % a AMP >1.8 cm.

  Parametr	Norma	Poznámka
  tloušťka bránice u spontánně ventilujícího pacienta v inspiriu	1.8-3.0 mm
  tloušťka bránice u spontánně ventilujícího pacienta v exspiriu	1.7 mm	pod 1.7 mm atrofie bránice
  Amplituda pohybů (AMP)	norma >1.8 cm	<1.2 cm hrozí selhání weaningu
  diaphragm thickening fraction (DTf)	norma > 55 %

Diaphragm thickening fraction:

Balíkova formule (doi 10.1007/s00134-005-0024-2 ):

V (ml)=20 x Sep (mm)

Celková kvalita obrazu:

• Excellent
• Good
• Fair
• Poor
• Non-diagnostic

If suboptimal (fair, poor, or non-diagnostic), explain the reason (e.g. large body habitus, pulmonary disease, small rib spaces, berast implants, difficulty positioning, mechanical ventilation).

Diagnostická výtěžnost:

• Excellent
• Good
• Inadequate