Flow Pattern Analysis Inside the Heart
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1 EAE Teaching Course. Sofia, 22. Cardiac Enegetics Flow Pattern Analysis Inside the Heart Jens-Uwe Voigt Dpt. of Cardiovascular Diseases Cath. University Leuven Belgium How to Describe Intracardiac Flow? Assessment of Cardiac Flow conventional echo Doppler... only for valve assessment Assessment of Cardiac Flow conventional echo Doppler... only for valve assessment... cannot display complex 2D/3D blood motion patterns Particle Imaging Velocimetry Particle Imaging Velocimetry by echo: following speckles in the blood contrast echo flow vectors frame 24 frame 25 frame 26 to estimate velocity, direction and pattern of blood flow
2 Particle Imaging Velocimetry PIV - Phantom Validation data analysis VD:,3286 VS: -,267 VL:,4748 VW:,243 SI:,9543 VO: 5,9355 Dtop:,439 Dbot:,892 Dlef:,289 Drig:,2528 RS:,379 VRS:,2723 VPC:,4444 sample volume velocity angle Phantom Measurements estimated vs. true velocity Phantom Measurements angle estimate vs. true velocity 8 true velocity profile 8 cut off here: 29.5 cm/s reasonable estimates despite high velocities 6 4 tracking 6 4 good tracking failure to track JU Voigt, University Leuven, C. Prinz, Belgium R. Faludi, et al., JASE (submitted) C. Prinz, R. Faludi, et al., JASE (submitted) Vortical Flow in the Heart simulation flow re-direction Normal LV courtesy: G Pedrezzetti 2
3 Energy Storage by Vortices effective re-direction of blood flow Energy Storage by Vortices mid-ventricular main vortex Tonti Intracavitary time sequence in the RV mitral E A aortic S in the RV determined by ventricular size dilated in the RV determined by ventricular size dilated Amzulescu, Leuven Amzulescu, Leuven 3
4 Determinants of Vortex Characteristics ventricular size vs. vortex area max. diast. vortex area [cm²] 5 5 y = 8,482Ln(x) - 5,46 R 2 =,9242 Ab Wall - Flow - Interaction RV enddiast. area [cm²] Amzulescu, Leuven Conduction Abities Conduction Abities LBBB AAI stimulation DDD stimulation Conduction Abities Conduction Abities LBBB AAI stimulation DDD stimulation AAI DDD Doppler strain % 4
5 Relative Vortex Size Time of Vortex Occurrence AAI stimulation DDD stimulation cardiac cycle rel. vortex size filling filling AAI IVR early filling dias late fill. IVC vortex present ejection ECG DDD IVR early filling dias late IVC ejection vortex present Gürel / Voigt, Leuven Gürel / Voigt, Leuven Energy Storage by Votices Conduction Abities estimation of energy dissipation diastolic energie dissipation RS LV Vortex ( x, y) dxdy ( x, y) dxdy 3 energydissipation (relative pulsatile vortex strength, RS) 2 p<.4 AAI DDD G. Pedrezzetti, Trieste Gürel / Voigt, Leuven Ab study: s vs. apical infarcts Ab Infarcts infarct 5
6 Ab study: s vs. apical infarcts infarct Ab study: post-infarct aneurysm & thrombus prosthesis Ab Pedrizzetti et al., Ann Biomed Eng 2 numerical simulations prosthesis numerical simulations ca. 3% increased energy dissipation during heart beat - prosthesis - Pedrizzetti et al., Ann Biomed Eng 2 Pedrizzetti et al., Ann Biomed Eng 2 6
7 Ab mitral valve prosthesis: tilt disc Ab mitral valve prosthesis: biologic (3CV) Faludi / Voigt, J Thor Cardiovasc Surg 2 Faludi / Voigt, J Thor Cardiovasc Surg 2 3 energydissipation Mitral Valve Prosthesis diastolic energie dissipation *) p<.5 vs. (relative pulsatile * vortex strength, RS) native MV 2 * Summary Modern speckle tracking technology allows to follow the motion of contrast enhanced blood in the heart. Flow patterns can be displayed and quantified using parameters such as vorticity. This echocardiographic particle imaging velocimetry (PIV) offers new insights into intraventricular hemodynamics and, thus, the energetics of cardiac function. native MV bi-leaflet biologic tilt disc Faludi / Voigt, J Thor Cardiovasc Surg 2 The clinical importance of this technique remains to be determined. 7
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