L ecocardiografia nello Scompenso Cardiaco Acuto e cronico: vecchi dogmi e nuovi trends.

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1 V SESSIONE SCOMPENSO CARDIACO 2015 Genova, Novembre 2015 L ecocardiografia nello Scompenso Cardiaco Acuto e cronico: vecchi dogmi e nuovi trends. Gian Paolo Bezante, MD, FACC UOC Clinica di Malattie dell Apparato Cardiovascolare IRCCS Azienda Ospedale Università San Martino - Genova

2 DEFINITION Heart failure (HF): A clinical syndrome of inadequate oxygen delivery to metabolizing tissues resulting from any cardiac structural or functional impairment of ventricular filling or ejection of blood Eur Heart J 2012;33: Circulation 2013;128:e

3 HF PATHOPHYSIOLOGY Normal HFrEF HFpEF

4 Echocardiographic examination showing dilated cardiomyopathy and depressed left ventricular (LV) systolic function in a patient admitted for acute dyspnoea. Patrizio Lancellotti et al. Eur Heart J Cardiovasc Imaging 2015;16:

5

6 Real Time 3D Volume Measurements

7 NORMALE ECOCARDIOGRAFIA 3D DISSINCRONO systolic dyssynchrony index 0,62% systolic dyssynchrony index 11,22% Azienda Ospedaliera Universitaria - Ferrara Napoli 2011

8 Echo Right Heart Catheterization

9 Schematic of pulse-wave Doppler of mitral inflow, color M-mode demonstrating mitral inflow propagation velocity, and tissue Doppler of the septal mitral annulus in normal diastolic function and various stages of diastolic dysfunction. J.K. Oh Eur J Echocardiogr 2007;8:4-14

10 Echocardiographic examination showing preserved left ventricular (LV) systolic function in a patient admitted for acute dyspnoea. Patrizio Lancellotti et al. Eur Heart J Cardiovasc Imaging 2015;16:

11 Diagnosis of heart failure with preserved left ventricular (LV) ejection fraction (EF) in a patient presenting with dyspnoea. Patrizio Lancellotti et al. Eur Heart J Cardiovasc Imaging 2015;16:

12 Three patients with a similar degree of shortness of breath. J.K. Oh Eur J Echocardiogr 2007;8:4-14

13 A: Parasternal long axis view from a middle-aged man with heart failure. J.K. Oh Eur J Echocardiogr 2007;8:4-14 Copyright 2006, The European Society of Cardiology

14 Practical approach to grade diastolic dysfunction by echocardiography. Patrizio Lancellotti et al. Eur Heart J Cardiovasc Imaging 2015;16:

15 RADIAL STRAIN DYSSYNCHRONY Azienda Ospedaliera Universitaria - Ferrara Napoli 2011

16 Sample of regional longitudinal strain (APLAX: apical long-axis, 4CH: four-chamber view, 2CH: two-chamber view) a bulls-eye representation in a patient with cardiac amyloidosis. Patrizio Lancellotti et al. Eur Heart J Cardiovasc Imaging 2015;16:

17 Regional longitudinal strain (bulls-eye representation) in a patient with hypertrophic cardiomyopathy. Patrizio Lancellotti et al. Eur Heart J Cardiovasc Imaging 2015;16:

18

19 Fundamental and second harmonic signal separated by filter Fundamental Signal from septum Noise from LV cavity harmonic

20 Second Harmonic TDI Fundamental, f=1.67mhz Second harmonic, f=3.33mhz Fundamental and second harmonic calculated from the same data set No significant noise difference Second harmonic TDI gives more aliasing.

21 Second Harmonic SRI Fundamental, f=1.67mhz Second harmonic, f=3.33mhz Fundamental and second harmonic calculated from the same data set Significant noise reduction when using the second harmonic frequency band Aliasing is not a problem due to small velocity differences

22 Myocardial velocity and strain rate with 300 frames/sec Velocity v 1 v 2 Strain rate Time

23 SPECKLE-TRACKING ECHOCARDIOGRAPHY: Comprehensive assessment of myocardial deformation Longitudinal deformation Base Circumferential deformation Radial deformation LONGITUDINAL Radial deformation CIRCUMFERENTIAL TORSION Torsion Torsional deformation Apex RADIAL Azienda Ospedaliera Universitaria - Ferrara Napoli 2011

24 Speckle-Tracking Echocardiography 2D Global Longitudinal strain

25 3D RT-STE - 4D Global Longitudinal Strain

26 Limiti e Potenzialita

27 HF PATHOPHYSIOLOGY Normal HFrEF HFpEF

28 Transthoracic lung ultrasound reveals multiple sonographic B-lines (ultrasound lung comets, white arrows) in a patient with acute pulmonary oedema. Patrizio Lancellotti et al. Eur Heart J Cardiovasc Imaging 2015;16:

29 Integrazione delle informazioni con ultrasuoni con parametri clinici e bioumorali per guidare interventi terapeutici

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