DISCLOSURE. Myocardial Mechanics. Relevant Financial Relationship(s) Off Label Usage

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1 7th Annual Team Echocardiography: The Heart of Cardiovascular Medicine Tissue Doppler, Strain, Speckle: What? How? Christopher J Kramer RDCS Aurora Medical Group Advanced Cardiovascular Services, Aurora Sinai/St. Luke s Medical Centers, Milwaukee, WI DISCLOSURE Relevant Financial Relationship(s) None Off Label Usage None Myocardial Mechanics Tissue Velocity Strain/Strain Rate Speckle Tracking Examples 1

2 Tissue Velocity Concept: Doppler records and velocities of moving targets Normal blood velocities range from 10 cm/s in the venous circulation to 150 cm/s Tissue Doppler is much lower 1-20 cm/s Produces greater amplitudes Tissue Doppler Estimation of Left Ventricular filling pressure 2

3 LV Assessment Restriction vs Constriction HV Insp reversal Exp reversal TDI Annulus Myocardial Pericardial 0.06 m/s 0.12 m/s Tissue Doppler CRT/Dyssynchrony Color coded tissue BART Blue Away/Red Toward Q Analysis AVO AVC 3

4 Pulse Wave TVI and 2D TVI Q Analysis S E A CP Time to Peak Systolic Velocity AVO 277ms AVC AVO AVC 340ms - 277ms = 63ms 4

5 Basal and Mid Segments AVO AVC 4 Chamber AVO AVC 2 Chamber AVO AVC Report Standard Deviation 45 (<33) Maximum Difference 114 (<100) 5

6 JASE: June 2009 Right Ventricle Tissue Velocity Normal Abnormal 6

7 Peak Systolic Velocity Pitfalls with Tissue Doppler Velocity Analysis Goal: : Detect regional wall thickening/thinning Concern: : Motion secondary to rotation and translation induced by adjacent segments. Solution: Evaluate the timing of wall motion not the absolute velocities? To measure local deformation (Strain rate and strain imaging)? Goal To Detect Regional Wall thickening 7

8 Pitfall (Velocity Analysis) Translation and Tethering Myocardial strain Used to describe elastic properties of cardiac muscle (Mirsky and Parmley: Circ Res, 1973) Strain (ε) = L 1 -L 0 L 0-20% 10 Strain rate cm 8 cm L 0 L 1 +20% 12 cm 0% 10 cm STRAIN AND STRAIN RATE Rate at which the myocardial segment shortens or lengthens. Temporal derivative of Strain Derivative Integral % Shortening or lengthening The temporal integral of Strain rate 8

9 All Can be Estimated from Velocity Data Tissue velocity imaging Real-time time integration Tissue tracking imaging Strain rate imaging Real-time spatial derivation b+5.0 s -1 Strain imaging Real-time time integration -5.0 s -1 Normal values: Longitudinal strain rate: s -1 Longitudinal strain: % Variability: Coefficient of variation: 6-9% (SR) 4-6% (Strain) Limitation to Clinical Use Significant user input Manual generation of information Time delay Noise/variability (signal to noise ratio) Additional images required (DTI) 9

10 DTI Evaluation of data along single scan line Speckle tracking Doppler Movement of the myocardium relative to the sample volume fixed in space 10

11 Tissue velocity Doppler Acoustic pattern tracking Automated selection of stable acoustic patterns Green dots = initial position of tracked point Red dots = final position of tracked point Slide: Peter Lysysanksy Acoustic pattern tracking Speckle Tracking Velocity is estimated as a shift of each object divided by time between successive frames (or multiplied by Frame Rate)--> 2D velocity vector: (Vx, Vy) = (dx, dy) * FR Y dy 0 dx New location Old location X Slide: Peter Lysysanksy 11

12 Velocity Vector Imaging (Siemens Sequoia ) 2D Speckle Tracking (GE Vivid 7) Movie GE Movie VVI Doppler Independent Techniques (Speckle Tracking) Potential Advantage? Signal noise Speckle tracking by principle is angle independent Gray scale (standard views) Monitor strain in two rather than one dimension Minimal user input (AFI) Assessment of rotation: derived from circumferential strain at different levels in the heart (NO( fixed sample volume) 2D Strain Imaging Apical 4-chamber Short-axis Transverse Longitudinal 12

13 Automated Analysis Automated Functional Imaging (AFI) Automated Analysis Automated Functional Imaging (AFI) Automated Analysis Automated Functional Imaging (AFI)

14 Automated Analysis Automated Functional Imaging (AFI) Automated Analysis Automated Functional Imaging (AFI) Automated Analysis Automated Functional Imaging (AFI) 14

15 Examples info/milwaukee_wi_listings/rentals_listings.shtml 15

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