New modalities in clinical cardiac imaging Speckle Tracking Symposium 2009 Hartcentrum OLVG.
-
Upload
cody-barber -
Category
Documents
-
view
222 -
download
6
Transcript of New modalities in clinical cardiac imaging Speckle Tracking Symposium 2009 Hartcentrum OLVG.
![Page 1: New modalities in clinical cardiac imaging Speckle Tracking Symposium 2009 Hartcentrum OLVG.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649d835503460f94a69f2b/html5/thumbnails/1.jpg)
New modalities in clinical cardiac imaging
Speckle Tracking
New modalities in clinical cardiac imaging
Speckle Tracking
Symposium 2009 Hartcentrum OLVG
![Page 2: New modalities in clinical cardiac imaging Speckle Tracking Symposium 2009 Hartcentrum OLVG.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649d835503460f94a69f2b/html5/thumbnails/2.jpg)
Demonstrates in 1793 the use of echo-reflection by bats
L. Spallanzani (1729 – 1799)
![Page 3: New modalities in clinical cardiac imaging Speckle Tracking Symposium 2009 Hartcentrum OLVG.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649d835503460f94a69f2b/html5/thumbnails/3.jpg)
The supersonic reflectoscopeThe supersonic reflectoscope
![Page 4: New modalities in clinical cardiac imaging Speckle Tracking Symposium 2009 Hartcentrum OLVG.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649d835503460f94a69f2b/html5/thumbnails/4.jpg)
Malmö, May 1953Malmö, May 1953Kockum’s Shipbuilding Cie
![Page 5: New modalities in clinical cardiac imaging Speckle Tracking Symposium 2009 Hartcentrum OLVG.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649d835503460f94a69f2b/html5/thumbnails/5.jpg)
Malmö, May 1953Malmö, May 1953
C.H. Hertz (1920- 1990)
![Page 6: New modalities in clinical cardiac imaging Speckle Tracking Symposium 2009 Hartcentrum OLVG.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649d835503460f94a69f2b/html5/thumbnails/6.jpg)
First steps in cardiac evaluation
First steps in cardiac evaluation
First M-mode cardiogram Structure identification
I. Edler, H. Hertz
Edler I. Ultrasoundcardiography. Suppl to Acta Med Scand, 1961;170
![Page 7: New modalities in clinical cardiac imaging Speckle Tracking Symposium 2009 Hartcentrum OLVG.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649d835503460f94a69f2b/html5/thumbnails/7.jpg)
Dynamic two-dimensional echocardiography (1971)Dynamic two-dimensional echocardiography (1971)
Bom N et al. Biomed-Engng 1971; 6: 500-3
![Page 8: New modalities in clinical cardiac imaging Speckle Tracking Symposium 2009 Hartcentrum OLVG.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649d835503460f94a69f2b/html5/thumbnails/8.jpg)
Moore’s LawMoore’s Law
Gordon MooreElectronics, 1965:38:8
![Page 9: New modalities in clinical cardiac imaging Speckle Tracking Symposium 2009 Hartcentrum OLVG.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649d835503460f94a69f2b/html5/thumbnails/9.jpg)
New modalitiesNew modalities
2D Strain imaging◦ Speckle tracking
3D echocardiography◦ 3D EF◦ Valve pathology◦ 3D TEE
![Page 10: New modalities in clinical cardiac imaging Speckle Tracking Symposium 2009 Hartcentrum OLVG.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649d835503460f94a69f2b/html5/thumbnails/10.jpg)
ConstellationsConstellations
![Page 11: New modalities in clinical cardiac imaging Speckle Tracking Symposium 2009 Hartcentrum OLVG.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649d835503460f94a69f2b/html5/thumbnails/11.jpg)
2D strainNon-doppler strainTissue deformation
“natural acoustic tagging”
Peter Lysyansky and Zvi Friedman
Speckle tracking pattern recognition algorithm
Speckle TrackingSpeckle Tracking
![Page 12: New modalities in clinical cardiac imaging Speckle Tracking Symposium 2009 Hartcentrum OLVG.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649d835503460f94a69f2b/html5/thumbnails/12.jpg)
2D Strain2D Strain
Apical PSSAX
Strain can be evaluated as
Longitudinal Transversal Radial Circumferential
L0 ∆L
![Page 13: New modalities in clinical cardiac imaging Speckle Tracking Symposium 2009 Hartcentrum OLVG.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649d835503460f94a69f2b/html5/thumbnails/13.jpg)
Speckle tracking of successive two-dimensional imagesSpeckle tracking of successive two-dimensional images
Notomi, Y. et al. J Am Coll Cardiol 2005;4:2034-2041
![Page 14: New modalities in clinical cardiac imaging Speckle Tracking Symposium 2009 Hartcentrum OLVG.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649d835503460f94a69f2b/html5/thumbnails/14.jpg)
Left ventricular rotation (LVrot) at apical and basal levels during systoleLeft ventricular rotation (LVrot) at apical and basal levels during systole
Notomi, Y. et al. J Am Coll Cardiol 2005;45:2034-2041
![Page 15: New modalities in clinical cardiac imaging Speckle Tracking Symposium 2009 Hartcentrum OLVG.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649d835503460f94a69f2b/html5/thumbnails/15.jpg)
In practiceIn practice
Apical level Basal Level
![Page 16: New modalities in clinical cardiac imaging Speckle Tracking Symposium 2009 Hartcentrum OLVG.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649d835503460f94a69f2b/html5/thumbnails/16.jpg)
TorsionTorsion
![Page 17: New modalities in clinical cardiac imaging Speckle Tracking Symposium 2009 Hartcentrum OLVG.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649d835503460f94a69f2b/html5/thumbnails/17.jpg)
Clinical applications of 2D StrainClinical applications of 2D Strain
Coronary artery disease Stress testing Left ventricular dyssynchrony Cardiomyopathy
![Page 18: New modalities in clinical cardiac imaging Speckle Tracking Symposium 2009 Hartcentrum OLVG.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649d835503460f94a69f2b/html5/thumbnails/18.jpg)
Evaluation of coronary artery diseaseEvaluation of coronary artery disease
2D Strain Acuraat & reproduceerbaar Subtiele WBS
Kwantificatie Ontrafelen van complexe myocardiale
contractie patronen:
Akinesie <6% Hypokinesie 6-18% Normokinesie >18% Hyperkinesie >24% Dyskinesie stretching Dyssynchronie regional timing
Ischemic response
Echocardiography 2009;3:299-306
![Page 19: New modalities in clinical cardiac imaging Speckle Tracking Symposium 2009 Hartcentrum OLVG.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649d835503460f94a69f2b/html5/thumbnails/19.jpg)
Ontrafelen van complexe contractie patronen
Ontrafelen van complexe contractie patronen
![Page 20: New modalities in clinical cardiac imaging Speckle Tracking Symposium 2009 Hartcentrum OLVG.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649d835503460f94a69f2b/html5/thumbnails/20.jpg)
2D Strain in practice2D Strain in practice
Plain 2D APLAX APLAX using 2D strain imaging
![Page 21: New modalities in clinical cardiac imaging Speckle Tracking Symposium 2009 Hartcentrum OLVG.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649d835503460f94a69f2b/html5/thumbnails/21.jpg)
2D strain results2D strain results
![Page 22: New modalities in clinical cardiac imaging Speckle Tracking Symposium 2009 Hartcentrum OLVG.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649d835503460f94a69f2b/html5/thumbnails/22.jpg)
Stress testingStress testing
Limitations stress echo: Subjective interpretation High level of expertise Moderate reproducibility
2D strain: Post processing Longitudinal strain Reliable measurements
![Page 23: New modalities in clinical cardiac imaging Speckle Tracking Symposium 2009 Hartcentrum OLVG.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649d835503460f94a69f2b/html5/thumbnails/23.jpg)
Stress testingStress testing Ischemic response
Longitudinal Before radial
Subendocardial fibers are oriented longitidinally
Diffusion Tensor Imaging (DTI)
![Page 24: New modalities in clinical cardiac imaging Speckle Tracking Symposium 2009 Hartcentrum OLVG.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649d835503460f94a69f2b/html5/thumbnails/24.jpg)
Viability assessmentViability assessment
Gradual decrease in strain with increasing transmurality of MI
2D strain: Excellent prognostic value for
functional recovery after revascularzation
OLVG: confirmation study 2D strain vs MRI
![Page 25: New modalities in clinical cardiac imaging Speckle Tracking Symposium 2009 Hartcentrum OLVG.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649d835503460f94a69f2b/html5/thumbnails/25.jpg)
Left ventricular dyssynchronyLeft ventricular dyssynchrony
Methods RT3DE
TDI
Disadvantages Limited availability Low spatial resolution
Angle dependent Active vs passive High framerate (>130FPS)
![Page 26: New modalities in clinical cardiac imaging Speckle Tracking Symposium 2009 Hartcentrum OLVG.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649d835503460f94a69f2b/html5/thumbnails/26.jpg)
Left ventricular dyssynchronyLeft ventricular dyssynchrony
Method 2D Strain
Advantages Operator independent Less artifacts Not angle dependent Proper quantification Higher sensitivity and
specificity regarding CRT responders
![Page 27: New modalities in clinical cardiac imaging Speckle Tracking Symposium 2009 Hartcentrum OLVG.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649d835503460f94a69f2b/html5/thumbnails/27.jpg)
Example of dyssynchronyExample of dyssynchrony
Synchroon Dyssynchroon
![Page 28: New modalities in clinical cardiac imaging Speckle Tracking Symposium 2009 Hartcentrum OLVG.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649d835503460f94a69f2b/html5/thumbnails/28.jpg)
Left ventricular dyssynchronyLeft ventricular dyssynchrony Assessing dyssynchrony with 2D strain
Time-to-peak radial strain of 2 segments- ≥130ms
SD of time-to-peak longitudinal strain of 12 segments
- ≥35ms
![Page 29: New modalities in clinical cardiac imaging Speckle Tracking Symposium 2009 Hartcentrum OLVG.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649d835503460f94a69f2b/html5/thumbnails/29.jpg)
CRT optimalizationCRT optimalization
Voor CRT Na CRT
![Page 30: New modalities in clinical cardiac imaging Speckle Tracking Symposium 2009 Hartcentrum OLVG.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649d835503460f94a69f2b/html5/thumbnails/30.jpg)
CRT optimalizationCRT optimalization
Voor CRT Na CRT
![Page 31: New modalities in clinical cardiac imaging Speckle Tracking Symposium 2009 Hartcentrum OLVG.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649d835503460f94a69f2b/html5/thumbnails/31.jpg)
CardiomyopathyCardiomyopathy
LVEF Simplistic approach
2D strain Subtle dysfunction Global vs. regional Early identification
Cardiovascular ultrasound 2007;5:27
![Page 32: New modalities in clinical cardiac imaging Speckle Tracking Symposium 2009 Hartcentrum OLVG.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649d835503460f94a69f2b/html5/thumbnails/32.jpg)
Confirmatie OLVG dataConfirmatie OLVG data
![Page 33: New modalities in clinical cardiac imaging Speckle Tracking Symposium 2009 Hartcentrum OLVG.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649d835503460f94a69f2b/html5/thumbnails/33.jpg)
Subtiele afwijkingenSubtiele afwijkingen
Impaired longitudinal motion before EF.
Infiltratieve CM NC CMP HCM HT CMP ARVC
![Page 34: New modalities in clinical cardiac imaging Speckle Tracking Symposium 2009 Hartcentrum OLVG.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649d835503460f94a69f2b/html5/thumbnails/34.jpg)
2D strain in cardiomyopathy2D strain in cardiomyopathy
![Page 35: New modalities in clinical cardiac imaging Speckle Tracking Symposium 2009 Hartcentrum OLVG.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649d835503460f94a69f2b/html5/thumbnails/35.jpg)
Offline 2D strain analysisOffline 2D strain analysis
![Page 36: New modalities in clinical cardiac imaging Speckle Tracking Symposium 2009 Hartcentrum OLVG.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649d835503460f94a69f2b/html5/thumbnails/36.jpg)
Morbus FabryMorbus Fabry
![Page 37: New modalities in clinical cardiac imaging Speckle Tracking Symposium 2009 Hartcentrum OLVG.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649d835503460f94a69f2b/html5/thumbnails/37.jpg)
HCM vs LVH due to hypertensionHCM vs LVH due to hypertension
Differentiation by strain analysis
HCM Segmental abnormalities
- Hypokinesie- Prestretching- Post-systolic shortening
JASE 2003;16:233-239
![Page 38: New modalities in clinical cardiac imaging Speckle Tracking Symposium 2009 Hartcentrum OLVG.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649d835503460f94a69f2b/html5/thumbnails/38.jpg)
HCMHCM
![Page 39: New modalities in clinical cardiac imaging Speckle Tracking Symposium 2009 Hartcentrum OLVG.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649d835503460f94a69f2b/html5/thumbnails/39.jpg)
WMA’s bij HCMWMA’s bij HCM
![Page 40: New modalities in clinical cardiac imaging Speckle Tracking Symposium 2009 Hartcentrum OLVG.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649d835503460f94a69f2b/html5/thumbnails/40.jpg)
HCMHCM
Apical HCM; EF preserved Strain highlights the link between abnormality and
systolic mechanics
![Page 41: New modalities in clinical cardiac imaging Speckle Tracking Symposium 2009 Hartcentrum OLVG.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649d835503460f94a69f2b/html5/thumbnails/41.jpg)
Rechter ventrikel functieRechter ventrikel functie
Evaluatie RVMotion independent deformation parameters (S, SR) appear superior in the accurate description of regional RV function.
Heart. Published Online First: 30 August 2009. doi:10.1136
![Page 42: New modalities in clinical cardiac imaging Speckle Tracking Symposium 2009 Hartcentrum OLVG.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649d835503460f94a69f2b/html5/thumbnails/42.jpg)
ARCVARCV
2D strain superieur aan TAPSE
![Page 43: New modalities in clinical cardiac imaging Speckle Tracking Symposium 2009 Hartcentrum OLVG.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649d835503460f94a69f2b/html5/thumbnails/43.jpg)
Use 2D Strain for follow upUse 2D Strain for follow up
![Page 44: New modalities in clinical cardiac imaging Speckle Tracking Symposium 2009 Hartcentrum OLVG.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649d835503460f94a69f2b/html5/thumbnails/44.jpg)
Tips and TricksTips and Tricks
Image quality: noice & near field clutter Frame rate (40-90 Hz) Region of interest (ROI): dikte vh myocard Endocardiac border tracing: Visual confirmation Check AVC settings
![Page 45: New modalities in clinical cardiac imaging Speckle Tracking Symposium 2009 Hartcentrum OLVG.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649d835503460f94a69f2b/html5/thumbnails/45.jpg)
Future developments: 3D StrainFuture developments: 3D Strain
Jacc 2008;51 Suppl A, A116 (abstract)
![Page 46: New modalities in clinical cardiac imaging Speckle Tracking Symposium 2009 Hartcentrum OLVG.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649d835503460f94a69f2b/html5/thumbnails/46.jpg)
Keep watching the specklesThere is more to come!
Keep watching the specklesThere is more to come!