Assessment of cardiac function with 3D echocardiography. Đánh giá chức năng tim bằng siêu âm tim 3D
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1 Assessment of cardiac function with 3D echocardiography Đánh giá chức năng tim bằng siêu âm tim 3D TS. BS. Nguyễn Thị Thu Hoài Viện Tim Mạch Quốc Gia Việt Nam
2 TỪ SIÊU ÂM M-mode ĐẾN SIÊU ÂM 3D
3 TỪ SIÊU ÂM 2D ĐẾN SIÊU ÂM 3D
4 Siªu m 3D realtime (4D) Am Heart J;130:
5
6 CÁC DẠNG BIỂU DIỄN HÌNH ẢNH SIÊU ÂM TIM 3D GÓC QUÉT HẸP PHÓNG ĐẠI TẬP TRUNG GÓC QUÉT RỘNG
7 CÁC DẠNG BIỂU DIỄN HÌNH ẢNH SIÊU ÂM TIM 3D LÁT CẮT MỎNG
8 TRÌNH BÀY HÌNH ẢNH SIÊU ÂM TIM 3D PHÓNG ĐẠI HÌNH ẢNH (ZOOM MODE)
9 PHÓNG ĐẠI HÌNH ẢNH (ZOOM MODE)
10 TRÌNH BÀY HÌNH ẢNH SIÊU ÂM TIM 3D HAI MẶT CẮT SIÊU ÂM VUÔNG GÓC NHAU (XPlane)
11 TRÌNH BÀY HÌNH ẢNH SIÊU ÂM TIM 3D DẠNG BỀ MẶT
12 How do we assess HOW WE ASSESS LV FUNCTION Eye ball (Eye ball) Eye ball LV Function? LV Function? Limitations imitations Subjective Experience dependent Subjective Lack of standardization Experience dependent Large inter- and intraobserver variability Lack of standardizatio
13 Lang RM, Badano L, J Am Soc Echocardiogr 2015;28:1-39
14 Evaluation of 2D EVALUATION OF 2D ECHOCARDIOGRAPHY Echocardiography: 2013 Hand tracing Correct view? Foreshortening? Correct shape? Geometry dependent? Tracing errors? Correct trace?
15 Chamber Quantification
16 Improved Image Quality and Frame Rate
17 Why is 3D More Accurate? long axis (cm) A4C * 7 2D 3D Mor-Avi V, Lang RM et al., Circulation :
18 RT3DE volume measurements: Validation by MRI EDV, ESV Excellent correlation (r²>0.85) Ahmad M, et al. J Am Coll Cardiol 2001; 37: Qin JX, et al. J Am Coll Cardiol 2000; 36:900-7 Arai K, et al. Am J Cardiol 2004; 94:552-8 Jenkins C, et al. J Am Coll Cardiol 2004; 44: Kuhl HP, et al. J Am Coll Cardiol 2004; 43: Gutierrez-Chico JL, et al. Am J Cardiol 2005; 95:809-13
19 RT3DE volume measurements: Validation by MRI EDV, ESV Excellent correlation (r²>0.85) but RT3DE underestimates volumes Jacobs LD, et al. Eur Heart J 2005; 27:460-8 Sugeng L, et al. Circulation 2006; 114: Jenkins C, et al. J Am Soc Echocardiogr 2007; 20:962-8 Soliman OI, et al. Am Soc Echocardiogr 2007; 20:1042-9
20 End Diastolic Volume 2D RT3D 2D Biplane EDV y = 0.76x R 2 = RT3D ESV y = 0.89x R 2 = MRI MRI EDV: 2D-MRI ml EDV: RT3D-MRI ml Jacobs L et al., European Heart Journal 27: , 2006 MRI P<0.05 for difference in bias MRI
21 How Does 3DE Measure Up?
22 Human ventricles: Patient A Patient A Patient B Patient B Tracing error is the most important factor contributing Tracing LV volume error underestimation is the most important factor contributing to More Avi JACC 2008
23 Fully Automated Cardiac Chamber Quantification 3D RV End- Diastolic Volume 3D LV End- Diastolic Volume 3D RV End- Systolic Volume 3D RV Ejection Fraction 3D RA Volume at LV End-Systole 3D LV End- Systolic Volume 3D LV Ejection Fraction 3D LA Volume at LV End- Systole
24 Real-Time Automated Transthoracic Three-Dimensional Echocardiographic Left Heart Chamber Quantification using an Adaptive Analytics Algorithm Dilated Banana Sigmoid Septum Normal
25 Comparison with Manual Tracing LAV at LVES Correlation Bias LOA (1SD) No Corrections Comparison with CMR Correlation Bias LOA (1SD) LAV at LVES No corrections With corrections
26 Variability Automated 3D Mode Measurement 3DE-Manual Measurement Same Data Test- Retest without CC Testretest with CC interobserver with CC Intra- observer- Interobserver Intraobserver MRI LV EDV 0±0% 6±6% 5±5% 9±4% 10±4% 15±12% 4±6% LV ESV 0±0% 8±7% 9±9% 10±4% 12±4% 18±18% 8±8% LV EF 0±0% 8±9% 8±8% 9±6% 11±2% 21±8% 8±7% LA 0±0% 12±14% 8±4% 17±16% 3±3%
27 Time Savings for LV and LA Time Saving for LV and LA
28 Guidelines Currently, 3D TTE and TEE assessment of LV volumes and ejection fraction is recommended over the use of 2DE, as it has been clearly demonstrated to provide more accurate and reproducible measurements. Lang, RM. Et al. J Am Soc Echocardiogr 2012;25:3-46. Lang RM et al, JASE 2012
29 LV mass Measurements Mor-Avi V, et al. Circulation 2004; 110, LV mass (g) CMR 2DE RT3DE Kei Mizukoshi, MD 1,2, Masaaki Takeuchi, MD 1
30 Right Ventricular Contraction Complex contraction pattern. Inward movement of the free wall (bellows effect) Minor axis shortening Long-axis shortening draws the TV towards the apex
31 3DE FOR ASSESSING THE RIGHT VENTRICLE What We Actually What We Measure Actually by Measure 2D Echo by 2D Echo 3DE FOR ASSESSING THE RIGHT VENTRICLE What We Actually Measure by 2D Echo What we actually measure by 2D echo 4-chamber view 4-chamber view What We Actually Measure by 2D Echo 4-chamber view 4-chamber view
32 3DE FOR ASSESSING THE RIGHT VENTRICLE Different probe positions, different linear measurements What We Actually Measure by 2D Echo 4-chamber view Lang RM, Eur Heart J Cardiovasc Imaging 2015
33 Inflow Right ventricle Free-wall surface Outflow Right ventricle Septal surface Body Inflow Apex
34 Bias: -11 ml LOA: ± 40 ml Bias: -0.3 ml LOA: ± 31 ml Bias: -3.3 % LOA: ± 15 %
35 Pressure Overload Volume Overload Indexed Curvature Indexed Curvature 1.5 Free wall surface Septal wall surface
36 3D Speckle Tracking 2D 3D
37 3D STE Tracks speckle motion irrespective of direction Ability to measure all 3 spatial components of myocardial displacement vector More homogenous spatial distribution of measured parameters in normal ventricles Reduced time for analysis Promise of accurate assessment of regional ventricular dynamics
38 3D STE Reproducibility and Variability
39 FUSION IMAGING Longitudinal Circumferential Radial
40 Co-registration allows to correlate coronary stenosis with regional wall motion abnormalities, using parametric display (% radial shortening) Control Severe stenosis associated with RWMA
41 Promises and Perspectives 3D Chamber Quantification Where have we been? Feasible Improved accuracy Improved reproducibility Mechanistic insights Where are we going? Improved temporal and spatial resolution Improved integration into clinical practice Automation Establish outcome measures/guidelines 3D Speckle tracking Decreased costs
42 THANK YOU VERY MUCH!
Conflict of Interests
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Conflict of Interests
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