Download Flow Pattern Analysis Inside the Heart

EAE Teaching Course
Sofia, 2012
.
.
Flow Pattern Analysis
Inside the Heart
Cardiac Enegetics
How to Describe
Intracardiac Flow ?
Jens-Uwe Voigt
Dpt. of Cardiovascular Diseases
Cath. University Leuven
Belgium
JU Voigt, University Leuven, Belgium
Assessment of Cardiac Flow
Assessment of Cardiac Flow
conventional echo
conventional echo
Doppler
Doppler
... only for valve assessment
... only for valve assessment
... cannot display complex
2D/3D blood motion
patterns
JU Voigt, University Leuven, Belgium
JU Voigt, University Leuven, Belgium
Particle Imaging Velocimetry
Particle Imaging Velocimetry
by echo: following speckles in the blood
frame 24
frame 25
contrast echo
flow vectors
frame 26
to estimate
velocity, direction and pattern
of blood flow
JU Voigt, University Leuven, Belgium
JU Voigt, University Leuven, Belgium
1
Particle Imaging Velocimetry
VD:
VS:
VL:
VW:
SI:
VO:
Dtop:
Dbot:
Dlef:
Drig:
RS:
VRS:
VPC:
data analysis
PIV - Phantom Validation
0,3286
-0,0267
0,4748
0,2430
1,9543
5,9355
0,4319
0,0892
0,1289
0,2528
1,3709
0,2723
0,4444
sample
volume
velocity
angle
100
JU Voigt, University Leuven, Belgium
JU Voigt, University Leuven, Belgium
Phantom Measurements
Phantom Measurements
estimated vs. true velocity
angle estimate vs. true velocity
100
true
velocity
profile
80
80
60
60
40
20
20
0
good
tracking
failure
to track
100
200
300
45
0
-45 0
20
40
60
80
100
-90
-135
0
0
reasonable estimates
despite high velocities
135
90
tracking
40
180
cut off here:
≈ 29.5 cm/s
0
20
40
60
80
100
-180
JU Voigt, University Leuven,
Belgium
C. Prinz,
R. Faludi, et al., JASE (submitted)
JU Voigt, University Leuven,
Belgium
C. Prinz,
R. Faludi, et al., JASE (submitted)
Assessment of Cardiac Function
Vortical Flow in the Heart
simulation
flow re-direction
Normal
LV Flow Patterns
JU Voigt, University Leuven, Belgium
courtesy: G Pedrezzetti
JU Voigt, University Leuven, Belgium
2
Tonti
Energy Storage by Vortices
Energy Storage by Vortices
effective re-direction of blood flow
mid-ventricular main vortex
JU Voigt, University Leuven, Belgium
JU Voigt, University Leuven, Belgium
Intracavitary Flow Patterns
Assessment of Cardiac Function
time sequence
Flow Patterns
in the RV
mitral
aortic
E
A
S
JU Voigt, University Leuven, Belgium
JU Voigt, University Leuven, Belgium
Flow Patterns in the RV
Flow Patterns in the RV
determined by ventricular size
normal
determined by ventricular size
dilated
JU Voigt, University Leuven, Belgium
normal
Amzulescu, Leuven
dilated
JU Voigt, University Leuven, Belgium
Amzulescu, Leuven
3
Determinants of Vortex Characteristics
Assessment of Cardiac Function
ventricular size vs. vortex area
15
max. diast.
vortex area
[cm²]
10
y = 8,0482Ln(x) - 15,146
Abnormal
Flow Patterns
2
R = 0,9242
5
Wall - Flow - Interaction
0
0
20
40
RV enddiast. area [cm²]
60
JU Voigt, University Leuven, Belgium
Conduction Abnormalities
normal
LBBB
Amzulescu, Leuven
JU Voigt, University Leuven, Belgium
Conduction Abnormalities
AAI stimulation
DDD stimulation
JU Voigt, University Leuven, Belgium
JU Voigt, University Leuven, Belgium
Conduction Abnormalities
Conduction Abnormalities
normal
LBBB
ET
AAI
DDD stimulation
DDD
ET
Doppler strain
AAI stimulation
ET
ET
10%
JU Voigt, University Leuven, Belgium
JU Voigt, University Leuven, Belgium
4
Relative Vortex Size
AAI stimulation
Time of Vortex Occurrence
DDD stimulation
cardiac cycle
IVR early filling dias late fill. IVC
rel.
vortex
size
filling
filling
ejection
AAI
vortex present
IVR
early filling dias late
IVC
ejection
DDD
ECG
vortex present
JU Voigt, University Leuven, Belgium
JU Voigt, University Leuven, Belgium
Gürel / Voigt, Leuven
Energy Storage by Votices
Conduction Abnormalities
estimation of energy dissipation
diastolic energie dissipation
energydissipation
1
RS
( x, y )dxdy
3
Gürel / Voigt, Leuven
p<0.004
(relative pulsatile
vortex strength, RS)
2
LV
0
( x, y )dxdy
1
Vortex
0
normal
JU Voigt, University Leuven, Belgium
G. Pedrezzetti, Trieste
Assessment of Cardiac Function
AAI
DDD
JU Voigt, University Leuven, Belgium
Gürel / Voigt, Leuven
Abnormal Flow Patterns
study: normals vs. apical infarcts
normal
infarct
Abnormal
Flow Patterns
Infarcts
JU Voigt, University Leuven, Belgium
JU Voigt, University Leuven, Belgium
5
Abnormal Flow Patterns
Abnormal Flow Patterns
study: normals vs. apical infarcts
study: post-infarct aneurysm & thrombus
normal
infarct
JU Voigt, University Leuven, Belgium
JU Voigt, University Leuven, Belgium
Assessment of Cardiac Function
Mitral Valve Replacement
normal
prosthesis
Abnormal
Flow Patterns
Mitral Valve Replacement
normal
JU Voigt, University Leuven, Belgium
JU Voigt, University Leuven, Belgium
Pedrizzetti et al., Ann Biomed Eng 2010
Mitral Valve Replacement
Mitral Valve Replacement
numerical simulations
numerical simulations
prosthesis
ca. 30% increased
energy dissipation
during 1 heart beat
- prosthesis
- normal
JU Voigt, University Leuven, Belgium
Pedrizzetti et al., Ann Biomed Eng 2010
JU Voigt, University Leuven, Belgium
Pedrizzetti et al., Ann Biomed Eng 2010
6
Abnormal Flow Patterns
Abnormal Flow Patterns
mitral valve prosthesis: tilt disc
mitral valve prosthesis: biologic (3CV)
JU Voigt, University Leuven,Faludi
Belgium
/ Voigt, J Thor Cardiovasc Surg 2010
energydissipation
JU Voigt, University Leuven,Faludi
Belgium
/ Voigt, J Thor Cardiovasc Surg 2010
Mitral Valve Prosthesis
Summary
diastolic energie dissipation
Modern speckle tracking technology allows to
follow the motion of
contrast enhanced blood in the heart.
3
*
(relative pulsatile
vortex strength, RS)
*
*) p<0.05 vs.
native MV
2
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.
1
0
native MV
bi-leaflet
biologic
tilt disc
JU Voigt, University Leuven,Faludi
Belgium
/ Voigt, J Thor Cardiovasc Surg 2010
The clinical importance of this technique
remains to be determined.
JU Voigt, University Leuven, Belgium
7