DECLARATION OF CONFLICT OF INTEREST. None

Transcription

1 DECLARATION OF CONFLICT OF INTEREST None

2 Hot Topics in Echocardiography: The position of the EAE EAE / ASE recommendation about Echo Assessment of Cardiac Mechanics Jens-Uwe Voigt Dpt. of Cardiovascular Diseases Cath. University Leuven Belgium

3 Assessment of Cardiac Mechanics... a tissue Doppler history 1961 Yoshida T. Analysis of heart motion with ultrasonic Doppler method and its clinical application. Am Heart J 1961;61: McDicken, Colour Doppler velocity Imaging of the Sutherland myocardium. Ultrasound Med Biol 1992;18:651-4

4 Strain Rate Imaging introduction of Strain Rate Imaging A Heimdal et al., JASE 1998;11,1013-9

5 Strain Rate Imaging Strain Rate Imaging Velocity Strain Rate Ultrasound Tissue Characte Is Strain Rate Imaging Applicable to the Clinical Setting? Elastic Deformation Properties Strain, Strain Rate stress l Strain d v 1 v 2 SR Strain Rate Imaging l 0 Strain Rate d f f 1 v 2 0 c v1 v2 StrainRate d SR [Hz] Peak Systolic Strain Rate 1 SR [Hz] IVR Peak Strain Rate Wall Motion Score Wall Motion Score Voigt, Sutherland, et al., Euroecho Trieste 1998 JUV 98

6 Leitman et al., JASE 2004;17: Speckle Tracking

7 Expert Consensus Statement Mor-Avi, Lang, Badano, Belohlavek, Cardim, Derumeaux, Galderisi, Marwick, Nagueh, Sengupta, Sicari, Smiseth, Smulevitz, Takeuchi, Thomas, Vannan, Voigt, Zamorano Eur J Echocardiogr 2011; 12:

8 basic parameters of myocardial function technology tissue Doppler / Doppler based deformation imaging 2D speckle tracking 3D speckle tracking integrated backscatter findings EAE / ASE Expert Consensus physiologic findings pathologic changes

9 EAE / ASE Expert Consensus published findings strengths / weaknesses / unresolved issues pitfalls recommendations

10 Different Vendors scan results vs. phantom scanner B scanner E Lars Ake Brodin, Stockholm (Euroecho 2010)

11 EAE / ASE Expert Consensus Integrated Backscatter

12 Integrated Backscatter

13 EAE / ASE Expert Consensus Rotational Deformation

14 Rotational Deformation distance [mm] rotation [ ] rotation [ ] twist [ ] (difference) torsion [ /mm] (normalized to distance)

15 LV Rotational Deformation stroke volume dependence EF 60% EF 30% model: HF Choi, Leuven

16 LV Torsion in MR torsion vs. radial function in valve disease controls non-ischemic MR Borg et al., Heart 2008

17 EAE / ASE Expert Consensus Dyssynchrony

18 CRT Patient Selection ventricular dyssynchrony electrical asynchrony? mechanical asynchrony patient selection lead position optimization follow up

19 PROSPECT Study added predictive value of echo parameters Circulation 2008, 117;

20 Synchronous Velocity Peaks

21 Asynchronous Deformation!

22 Deformation Imaging CRT off ET CRT on ET

23 Apical Rocking 4 chamber view: septal - lateral motion ET ET towards lateral 5mm towards septal ECG Voigt et al., Eur Heart J 2009

24 The New ESC Guidelines on CRT Dickstein et al., Eur Heart J 2010

25 EAE / ASE Expert Consensus Diastolic Function

26 filling pressure Estimating Filling Pressure filling pressure vs. E/e E to E ratio E to E ratio Nagueh et al., JACC 1997 Ommen et al., Cirulation 2000

27 E/e and Diastolic Function E/e vs. filling pressure Δ E/e vs. Δ filling pressure Mullens, Circulation 2009

28 Estimation of Filling Pressures... with impaired LV function Mitral E/A E/A < 1 E < 50cm/s E/A or > 50cm/s E/A > 2 DT < 150cm/s E/e < 8 S/D > 1 Ar-A < 0ms PAPs < 30mmHg... E/e > 15 S/D < 1 Ar-A > 30ms PAPs > 35mmHg... filling pressure normal filling pressure elevated EAE / ASE Recommendations (Nagueh et al., Eur J Echocardiogr 2009)

29 Estimation of Filling Pressures... with normal LV function Mitral E/e E/ < 8 E/e E/e > 13 LA Vol. < 34ml/m² Ar-A < 0ms PAPs < 30mmHg... LA Vol. > 34ml/m² Ar-A > 30ms PAPs > 35mmHg... filling pressure normal filling pressure elevated EAE / ASE Recommendations (Nagueh et al., Eur J Echocardiogr 2009)

30 EAE / ASE Expert Consensus Ischemia

31 Tissue Velocity Imaging stress echocardiography: anteroseptal ischaemia baseline peak stress

32 Tissue Velocity Imaging peak systolic velocity vs. regression model LAD model y = (0.053 peak heart rate)-(1.384 Sex)-(0.168 BA PSV)-(0.205 ML PSV) LAD model velocity only including - peak syst. velocity of 2 segments - heart rate - sex - constant MYDISE (Mädler, Fraser et al.) EHJ 2003;24,

33 Deformation Imaging myocardial deformation properties strain, strain rate stress l Strain l l 0 l 0 Strain Rate d Strain d t

34 Deformation Imaging acute ischemia during balloon occlusion AVC AVC AVC Kukulski et al., JASE 2002

35 EAE / ASE Expert Consensus Viability

36 Regional Function: Stunning Jamal et al., Circulation 2001: 16 pigs, regional radial strain during ischaemia and reperfusion thickening (radial strain) normal perfusion baseline ischaemia reperfusion myocardium, stained myocardium at risk AVC AVC AVC

37 Regional Function: Stunning Jamal et al., Circulation 2001: 16 pigs, regional radial strain during ischaemia and reperfusion thickening (radial strain) dobu 2.5 dobu 5 dobu days later normal perfusion AVC AVC AVC AVC myocardium at risk

38 Viability by Strain Rate Hoffmann et al., JACC 2002: Strain Rate Measurement by Doppler Echocardiography Allowes Improved Assessment of Myocardial Viability in Patients with Depressed LV Function.c baseline low dose dobutamine AVC AVC

39 EAE / ASE Expert Consensus Right Ventricle

40 RV Function Assessment tricuspid anular plane systolic excursion TAPSE vs. RVEF event free survival > 14 mm < 14 mm Ghio, AJC 2000

41 Deformation Imaging preoperative 1 week post 6 months post strain motion Giusca et al., Heart 2010

42 EAE / ASE Expert Consensus Conclusion

43 EAE / ASE Expert Consensus However: 1) more multicenter data needed 2) more standardization on what and how 3) standardization among manufacturers

44 come to

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