* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Assess Ventricular Systolic and Diastolic Function
Survey
Document related concepts
Management of acute coronary syndrome wikipedia , lookup
Cardiac contractility modulation wikipedia , lookup
Heart failure wikipedia , lookup
Artificial heart valve wikipedia , lookup
Aortic stenosis wikipedia , lookup
Jatene procedure wikipedia , lookup
Electrocardiography wikipedia , lookup
Myocardial infarction wikipedia , lookup
Lutembacher's syndrome wikipedia , lookup
Hypertrophic cardiomyopathy wikipedia , lookup
Quantium Medical Cardiac Output wikipedia , lookup
Ventricular fibrillation wikipedia , lookup
Arrhythmogenic right ventricular dysplasia wikipedia , lookup
Transcript
Assess Ventricular Systolic and Diastolic Function Robert J. Fleck, MD May 18, 2012 Assess Ventricular Systolic Function • Segmented K-space steady state free precession (SSFP) is the standard – Accurate – Reproducible – Published normal ranges for children • Buechel, JCMR 2009, 11:19 • Robbers-Visser, JMRI 2009, 29:552-559 • Systematic differences between fast gradient echo (FGE) and SSFP Common Questions? • • • • • • • • • • How to choose the basal slice? Do I include the LVOT? What about the apex? Include or exclude the papillary muscles? How do I identify the atrium? How do I know where the PV is located? Should I include or exclude the moderator band? How many slices do I need? Why do we breathhold in expiration? Why are there usually move LV contours than RV contours? How do I choose the basal slice? This is the most important slice! Is there thick myocardium? Does it encompass > 50% of the circumference when in diastole? Does it get bigger during systole? Then this is Atrium! Do I include the LVOT? • It is part of the LV, so it is included • Extend the epicardial contour to the aortic valve • Often easier to see on cine • Epicardial contour exclude fat Why is this slice so important? • End diastole has a volume of ventricle • End systole usually has no volume of ventricle • This is due to shortening of the valve plane during systole Basal slice movement 4 chamber end diastole 4 chamber end systole Why are there usually move LV contours than RV contours? • The tricuspid valve (TV) is displaced apically relative to the mitral valve (MV) • shows TV location • shows MV location How do I contour for the PV when I can’t see it? • Anatomically the PV and AoV are closely related • SA stack the PV is usually where the aorta and pulmonary artery cross Contouring the RV Start in the mid ventricle, it is easier and there are fewer decisions We don’t worry about the trabeculations, but this needs to be consistent between all readers of CMR What about the basal slice of RV? • Dialated RVs often extend beyond the TV plane • This volume is not present on systole – It is significant – Include it in your contours What about the basal slice of RV? End Diastole End Systole What about the basal slice of RV? First Basal Slice Second Basal Slice Other Questions QUESTION? • What about the apex? • Include or exclude papillary muscle? • Moderator band • How many slices do I need? • Why image at end expiration? ANSWER • This is a very small volume do worry too much about getting every last bit • Your choice • Exclude from the RV volume only if large • 10 to 14 slices should suffice • Postion of the heart is more consistent What is the most important advice? • CONSISTENCY –Within an Individual –Within a group • Avoid bias!! • Start contouring in the midventricle What to do with Tagged images? Advantage of measuring myocardial strain using tags • Assess local myocardial deformation • Quantitative analysis: Estimation of strain • HARP : Harmonic phase MRI – Fully automated and needs no interpolation • Strain myocardial deformation – If an element shorten, strain is negative – If an element lengthens, strain is positive Strain in Myocardium % STRAIN % = {(Length ED – Length ES)/Length ED}* 100 • Radial • Longitudinal • Circumferential Early Systole Late Systole Strain in Myocardium % STRAIN % = {(Length ED – Length ES)/Length ED}* 100 • Radial • Longitudinal • Circumferential Early Systole Late Systole Strain in Myocardium % STRAIN % = {(Length ED – Length ES)/Length ED}* 100 • Radial • Longitudinal • Circumferential Early Systole Late Systole Circumferential Strain (ECC%) Tagged Image Data Analysis : HARP 5% -25% Normal DMD The maximum circumferential strain is low in DMD compared to normal Dysynchrony A A B BC CA A control B DMD<10yrs C DMD>10yrs A B BC C Abnormal myocardial circumferential strain precedes global functional decline in Duchenne Muscular Dystrophy Why is tag derived strain better? Strain each cardiac MRI of a patient decreased over time because it is a measure of cardiac contractility Choose the statement that best describes the typical MR picture of restrictive cardiomyopathy in children: A. Increased left ventricular volume with decreased ejection fraction and thickened pericardium B. Increased left ventricular volume with normal ejection fraction and normal pericardium C. Normal left ventricular volume with decreased ejection fraction and thickened pericardium D. Normal left ventricular volume with normal ejection fraction and normal pericardium E. Normal left ventricular volume with decreased ejection fraction and dilated left atrium How do you assess diastolic dysfunction? RadioGraphics 2011; 31: 239-261 What is diastolic dysfunction? • Heart failure in the presence of preserved EF – Abnormal relaxation of myocardium – 40-50% of all cases of heart failure – High morbidity and mortality, especially in pediatrics • Causes – – – – – Age Hypertension Obesity and/or metabolic syndrome Diabetes Hypertrophic cardiomyopathy How is it assessed by MR? • We use the “easy way” – Left atrium (LA) interacts with the LV to give a “kick” of volume to stretch myocardium of the LV – Diastolic dysfunction causes dilation of the overworked LA – Overtime the LA integrates the effects of increase filling pressure of the LV – Beware - Atrial fibrillation and mitral valve stenosis or regurgitation can also cause dilation 4 chamber SSFP cine stack Contour the atrium Normal Values Sarikouch, JMRI 33: 1028 We consider >50 ml/m2 abnormal End Systole Thank you! ?? Questions ??