HIGHLIGHT SESSION. Imaging. J. L. Zamorano Gomez (Madrid, ES) Disclosures: Speaker Philips

Transcription

1 Imaging. J. L. Zamorano Gomez (Madrid, ES) Disclosures: Speaker Philips

2 Agenda ECHO Diagnosis & Prognosis : Functional MR Severity Aortic Stenosis CT How to select pts for TAVI Adding prognostic info to coronary arteries MRI Stress MRI to better select pts for Coronary angio LV mechanics as good as MRI to detect necrosis

3 The color doppler 3D echocardiography Aims derived vena contracta area is superior to the recommended integrative approach to quantify functional mitral regurgitation both at rest and during exercise To test the value of the three-dimensional echocardiography-derived vena contracta area (VCA) to quantify functional mitral regurgitation (FMR) at rest and during exercise in patients with systolic heart failure J. Vecera BE 136

4 Results Indices to assess FMR at rest and during exercise FMR increase (n=24) MR stable (n=36) p value 3D-VCA (mm²) Rest Exe 17 ± 5 42 ± 7 *** 11 ± 7 15 ± 7 * < < D-VCA length (mm) Rest Exe 7.9 ± ± 3.5 *** 4.0 ± ± 3.2 ** < < PISA ERO (mm²) Rest Exe 11 ± 4 23 ± 7 *** 8 ± 8 11 ± 10 ** 0,15 < D-VC (mm) Rest Exe 3.4 ± ± 1.2 *** 2.7 ± ± < JA / LAA (%) Rest Exe 13 ± 5 25 ± 11 *** 9 ± 9 12 ± < p < 0.05, p < 0.01, p < rest versus exercise vena contracta area (VCA) J. Vecera BE 136

5 What Conclusion is New in the Evaluation of Aortic Stenosis? 1. Valvulo-Arterial The presence of Impedance a relatively (Zva) large ellipsoid VCA at rest may be a marker of severe dynamic FMR 2. Cardiac despite Event-free the grading Survival of FMR as mild according to Ex-PHT 2. Thus, the assessment of VCA is highly sensitive to track exercise-induced changes in ERO while the PISA method shows lower sensitivity J. Vecera Magne BE

6 Left Ventricular Afterload in AS = Valvular Load + Arterial Load In Aortic stenosis Zva represents the cost in mmhg for each systemic ml of blood indexed for body size pumped by the left ventricle during systole. Courtesy from Dr Philippe Pibarot, Quebec Heart and Lung Institute, Qc, Canada. J. Magne BE 535

7 Maximal Exercise Capacity and Zva Zva provides an estimate of the global LV hemodynamic load that results from the summation of the valvular and vascular loads: stenosis severity volume flow rate body size systemic vascular resistance Dulgheru et al. ESC meeting 2012 J. Magne BE 535

8 Aortic Cardiac Annulus Event-free Area Assessment by Survival MDCT for Predicting according Paravalvular to Ex-PHT Regurgitation in Patients undergoing TAVI Aim of the study To compare the measurement of AoA area by MDCT versus AoA-A evaluation by TTE and by TEE and to assess their relationship with PVR after TAVI in patients treated with the Sapien prosthesis 12% of CV death in Ex-PHT group (vs. 0%) G. Pontone J. Magne IT BE

9 Results: Clinical Scenario regarding prosthesis implanted and occurrence of signifcant PVR AoA-D TEE : aortic annulus diameter by TEE; AoA-A MDCT : aortic annulus area by MDCT; PVR: paravalvular aortic regurgitation; MDCT: multidetector computed tomography; TEE: transesophageal echocardiography; *: p<0.05; : p<0.01. G. Pontone IT 1463

10 Conclusions Myocardial Fibrosis and Fat May be Substrates of Critical Ventricular Arrhythmia. Comparison of 320 Slice CT Images in Subjects Who had Ventricular Fibrillation with Sustained Ventricular Tachycardia This study shows that the lack of congruence between prosthesis and annulus size is associated with PVR. MDCT is a better tool for detecting the mismatch between prosthesis To identify area specific and organized aortic annulus substrates area of VF, and for predicting PVR Compared as compared 320 slice to CT TTE heart and images TEE. in non-ischemic subjects who had VF with those who had sustained and An non-sustained MDCT-based VT. approach may be a reliable method to select the appropriate prosthesis size for TAVI. In this regard, specific MDCT based sizing recommendations should be developed. G. K. Pontone Ozawa JP IT

11 Typical 320 Slice CT Images of myocardial fibrosis fatty change Early phase Early phase RV; LA ; right left atria, ventricle, LV; left LV; ventricle left ventricle Late phase Late phase K. Ozawa JP 3890

12 Results & Conclusion Comparison of frequency of myocardial fibrosis and fatty change on 320 slice CT among the 3 non ischemic arrhythmia Groups. In non-ischemic subjects myocardial fibrosis may be a substrate of VF and fatty change may be substrate of sustained VT 320 slice CT can evaluate coronary arteries and myocardium K. Ozawa JP 3890

13 Cardiovascular risk profile, long term survival and stress cardiac magnetic resonance imaging guided catheterization. Subgroup from cohort study Kelle et al.(2011) JACC. Cardiovasc. imaging. suspecte d CAD (N=924) Control group similar risk profile CMR (N=270) CA (N=654) negative (N=199) positive (N=71) negative (N=318) positive (N=336) CA (N=83) follow-up revascularisation (PCI/CABG) (N=342) death (N=89) Deutsches Herzzentrum Berlin E. Wellenhofer DE 3890

14 Value Results of I 3D group speckle-tracking comparison CMR/CA strain to identify transmural necrosis after STEMI: comparison against cardiac magnetic resonance Aims 1) To assess if 3D STE analysis enables an accurate and objective assessment of necrosis transmurality after STEMI, in comparison with the gold standard (i.e. delayed-enhancement cardiac magnetic resonance, DE-CMR); 2D&3D wall motion score DE-CMR 2D longitudinal strain versus Cardiac magnetic resonance imaging prior to cardiac angiography 3D strain was parameters significantly more effective in terms of death and hospitalization than cardiac angiography based Transmural necrosis = only on clinical findings, history and exercise ECG % DE/segment E. Wellenhofer D. Muraru DE IT

15 Identification of LV segments with transmural necrosis: 3D strain parameters vs 2D longitudinal strain vs expert 2D and 3D WMS on good-quality LV data sets AUC 95% CI WMS 3D LS 2D WMS 2D AS 3D CS 3D LS 2D 2D longitudinal strain; LS 3D 3D longitudinal strain; CS 3D 3D circumferential strain; RS 3D 3D radial strain; AS 3D 3D area strain RS 3D LS 3D D. Muraru IT 3892

16 Conclusions 3D strain parameters and 2D longitudinal strain had a good accuracy to identify segments with transmural necrosis when compared with the gold standard DE-CMR. Significant differences were found between 2D and 3D longitudinal strain, the former having a higher accuracy to identify transmural necrosis. WMS assessment by experienced readers on good-quality 3D data sets was found to be superior than WMS on 2D images and than strain quantification for the identification of segments with transmural necrosis. D. Muraru IT 3892

17 Take home messages ECHO New parameters of assessing diagnosis and prognosis of Valvular heart disease CT 3D Vena contracta for better assessment functional MR Valvulo arterial impedance and Exercise induced PHT for Ao Stenosis Seems to predict better than echo the ocurrence of paravalvular Reg after TAVI Myocardial patterns add prognostic info in non ischemic CM MRI Stress MI for better selection strategy before coronary angiogram LV mechanics assessed by echo an alternative to MR as an accurate method to detect necrosis