Strain imaging in children: from Tissue Doppler to 3 D
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1 Strain imaging in children: from Tissue Doppler to 3 D Mark kk. Friedberg Fi
2 Outline Deformation in the fetus and neonate Deformation in pediatric cardiomyopathy y (briefly!) Deformation in Congenital heart disease: Tetralogy of Fallot Hypoplastic leftheart syndrome cctga 3 D strain
3 Strain imaging M Mode in children: From M mode to 3D?
4 Normal strain values in pediatrics Weideman, JASE 2002;15:20
5 Normal strain values in pediatrics Lorch, JASE 2008 ; 21:1207
6 Lorch, JASE 2008 ; 21:1207
7 Lorch, JASE 2008 ; 21:1207
8 2D speckle tracking in the fetus Ta Shma A. J Am Soc Echocardiogr :
9 Velocity Vector Imaging in the Fetus Younoszai, JASE :470.
10 Evolution in neonatal life Pena, JASE 2010;23:294
11 Children with cardiomyopathy Show AFI
12 Children with cardiomyopathy
13 Radial strain to investigate dyssynchrony and function in DCM Controls Dilated Cardiomyopath y Anterior Septum 41.9 ± ± 13 < Anterior Wall 47.8 ± ± 12 < Lateral Wall 52.8 ± ± 10 < Posterior Wall 55 ± ± 10 < Inferior Wall 53.6 ± ± 13.6 < Inferior Septum 46 ± ± 12.8 < p Ra adial Dyssynchrony Inde ex (msec) Controls p< Dilated Cardiomyopathy Ave erage Peak Radial Strain (%) Inferior Septum Anterior Septum Inferior Wall Anterior wall Lateral Wall Posterior Wall 24 r=0.98 p< Average Time to Peak Strain (msec) Ave erage Peak Radial Strain (%) Inferior Septum Anterior Septum 14 Anterior Wall Inferior Wall Posterior Wall Lateral Wall Friedberg AJC, 2008 r=0.76 p= Average Time to Peak Radial Strain (msec)
14 Regional deformation by TDI strain in HCM Ganame, EHJ, , 2886
15 Speckle tracking for diagnosis of LVNC? Eidem, Pediatr Cardiol ;30:682 9.
16 Effect of anthracyclines on deformation Ganame, JASE 2007;20:1351
17 9y F, after chemotherapy
18 Congenital heart disease
19 Congenital heart disease and fiber orientation normal Superficial layers tricuspid atresia Different fiber orientation Different 3 D deformation Middle layers Sanchez Quintana, D et al. Heart 1999 ;81:182 normal tricuspid atresia Slide courtesy of Luc Mertens
20 Small/ absent contra lateral ventricle affects ventricular strain and torsion Fogel, Circulation 1998;98;330
21 RV strain Weideman, JASE 2002;15:20 8 0
22 RV deformation after ASD closure Eyskens, JASE 2006;19:994
23 RV strain in Pulmonary valve Stenosis Weidemann, Ped Cardiol, 2002;23:292
24
25 Strain and strain rate after TOF repair Weidemann, Am J Cardiol 2002;90:
26 Strain and strain rate after TOF repair Weidemann, Am J Cardiol 2002;90: Tzemos, AJC 2009; 103:420
27 RV strain/ SR in TOF Solarz, J Am Soc Echocardiogr 2004;17:
28 Strain and SR after PVR in TOF Knirsch, Pediatr Cardiol; :
29 Strain and SR after PVR in TOF N=58 Echo analysis at median intervals of 2.8 months before and 30 months after PVR. Kutty, JASE 2008;21:1216 Before After Control Frigiola, Circ. 2004;110[suppl II]:II 153 II 157
30 RV strain after catheter PVR Friedberg, Eur J Echo : 585
31 PVR: Short term changes in deformation n Pre PVR Post PVR p- value (mean ± SD) (mean ± SD) Strain LV % ± ± Strain IVS % ± ± Strain RV % ± ± Strain Rate LV (s -1 ) ± ± Strain Rate IVS (s -1 ) ± ± StrainRate RV (s -1 ) ± ± Septal Strain% Pre-Post PPVI Septal Strain % Series1 Series Series Series pre post Series5 Series Series7 Series Series Series Moiduddin, AJC 2009;104:862
32 LV function in TOF Friedberg, Eur J Echo , 585
33 LV deformation after TOF repair Weidemann, Am J Cardiol 2002;90:
34 TOF Controls P value Myocardial Deformation LV Radial strain base* 30±14 39±20 <0.01 mid* 36±16 50±22 <0.01 apex 38± 19 54±20 <0.01 LV Radial strain rate base* 1.5± ±0.82 <0.01 mid* 1.4± ±0.61 < apex 1.6± ± LV Circumferential strain base* -16±6-18±7 0.1 mid* -16±5-19±6 <0.01 apex -19+/-6 20+/ Longitudinal strain RV (base+mid) -23±5-27± LV (base+mid) -16±5-17±4 0.4 Fernandes, AEPC, 2010
35 LV dyssynchrony in TOF Abdul Khaliq, JACC 2005;45:915
36 Hypoplastic Left Heart Syndrome
37 Assessment of function in single ventricles
38 HLHS good RV Deformation Insert cpa strain curves
39 RV PA conduit vs BTS in Stage 1 Norwood Hughes, Heart 2004;90:
40 Dyssynchrony in HLHS using VVI Friedberg, JASE 2007;20:
41 Congenitally corrected transposition of the great arteries
42 Clinical deterioration in cctga is linked to RV failure Roos Hesselink, EHJ 2004; 25, 1264
43 Strain and SR after Senning in cctga LV posterior wall radial function Eyskens, Cardiol Young 2004; 14:
44 Asymptomatic patients with cctga Bos, JASE 2006;19:1033
45 RV adaptation after atrial switch Pettersen, JACC, 2007;49:2450
46 Impaired Diastolic Reserve in cctga Systemic Ventricle Pulmonary Ventricle Poerner J Am Soc Echocardiogr 2007;20:1 285
47 Serial Evaluation of LV function after ALCAPA repair Mertens, Cardiol Young, 2001
48 Child with ALCAPA
49 3D strain
50 Left Ventricular Deformation is 3 dimensional Courtesy of Ben Eidem, MD
51 We evaluate strain in 3 dimensions Longitudinal strain Radial strain Circumferential strain
52 Abstracts at the upcoming AHA Is LeftVentricular Twisting Obtained Using Three dimensional Ultrasound Speckle Tracking Imaging Useful in Assessing Left Ventricular Function? Comparison with Invasive Parameters Left Ventricular Eccentricity Impairs Three Dimensional Systolic Radial Strain and Torsion in Patients After Repair of Tetralogy of Fallot: A Three Dimensional Speckle Tracking Analysis
53 3 D strain
54 3 D strain
55 3 D rotation and torsion
56 17 year old with AS and AI
57 9 yr, girl, pulmonary stenosis
58 Problems using strain in clinical practice Technical acquisition Normal values vary between techniques and studies Large inter/ intra observer variability Large scatter/ variation compared to reference methods Conflicting data regarding load dependency dependency Regional vs global function what and where should we be measuring Which method should we be using S/ SR? Standardization (eg peak vs mean velocities (colour vs pulsed Doppler) Long post acquisition processing time Incorporation of results into clinical i l decision i making Data overload but small numbers
59
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