Download Second Harmonic TDI

V SESSIONE
SCOMPENSO CARDIACO 2015
Genova, 13-14 Novembre 2015
L’ecocardiografia nello
Scompenso Cardiaco
Acuto e cronico:
vecchi dogmi e nuovi
trends.
Gian Paolo Bezante, MD, FACC
UOC Clinica di Malattie dell’Apparato Cardiovascolare
IRCCS Azienda Ospedale Università San Martino - Genova
DEFINITION
 Heart failure (HF):
A clinical syndrome of inadequate oxygen
delivery to metabolizing tissues resulting from
any cardiac structural or functional impairment
of ventricular filling or ejection of blood
Eur Heart J 2012;33:1787-1847.
Circulation 2013;128:e240-327.
HF PATHOPHYSIOLOGY
Normal
HFrEF
HFpEF
Echocardiographic examination showing dilated cardiomyopathy and depressed left
ventricular (LV) systolic function in a patient admitted for acute dyspnoea.
Patrizio Lancellotti et al. Eur Heart J Cardiovasc Imaging 2015;16:119-146
Real Time 3D Volume Measurements
NORMALE
ECOCARDIOGRAFIA 3D
systolic dyssynchrony index 0,62%
Azienda Ospedaliera
Universitaria - Ferrara
DISSINCRONO
systolic dyssynchrony index 11,22%
Napoli 2011
Echo Right Heart Catheterization
Schematic of pulse-wave Doppler of mitral inflow, color M-mode demonstrating mitral inflow
propagation velocity, and tissue Doppler of the septal mitral annulus in normal diastolic
function and various stages of diastolic dysfunction.
J.K. Oh Eur J Echocardiogr 2007;8:4-14
Echocardiographic examination showing preserved left ventricular (LV) systolic function in a
patient admitted for acute dyspnoea.
Patrizio Lancellotti et al. Eur Heart J Cardiovasc Imaging 2015;16:119-146
Diagnosis of heart failure with preserved left ventricular (LV) ejection fraction (EF) in a patient
presenting with dyspnoea.
Patrizio Lancellotti et al. Eur Heart J Cardiovasc Imaging 2015;16:119-146
Three patients with a similar degree of shortness of breath.
J.K. Oh Eur J Echocardiogr 2007;8:4-14
A: Parasternal long axis view from a middle-aged man with heart failure.
J.K. Oh Eur J Echocardiogr 2007;8:4-14
Copyright © 2006, The European Society of Cardiology
Practical approach to grade diastolic dysfunction by echocardiography.
Patrizio Lancellotti et al. Eur Heart J Cardiovasc Imaging 2015;16:119-146
RADIAL STRAIN DYSSYNCHRONY
Azienda Ospedaliera
Universitaria - Ferrara
Napoli 2011
Sample of regional longitudinal strain (APLAX: apical long-axis, 4CH: four-chamber view,
2CH: two-chamber view) a bulls-eye representation in a patient with cardiac amyloidosis.
Patrizio Lancellotti et al. Eur Heart J Cardiovasc Imaging 2015;16:119-146
Regional longitudinal strain (bulls-eye representation) in a patient with hypertrophic
cardiomyopathy.
Patrizio Lancellotti et al. Eur Heart J Cardiovasc Imaging 2015;16:119-146
Fundamental and second
harmonic signal separated by
filter
250
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-20
450
0
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x 10
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Fundamental
0
-500
0
0
Signal
from
septum
500
-10
0
Noise from LV cavity
10
2. harmonic
Second Harmonic TDI
Fundamental, f=1.67MHz
• Fundamental and
second harmonic
calculated from the
same data set
• No significant noise
difference
Second harmonic, f=3.33MHz
• Second harmonic TDI
gives more aliasing.
Second Harmonic SRI
Fundamental, f=1.67MHz
Second harmonic, f=3.33MHz
• Fundamental and
second harmonic
calculated from the
same data set
• Significant noise
reduction when using
the second harmonic
frequency band
• Aliasing is not a
problem due to small
velocity differences
Myocardial velocity and strain rate
with 300 frames/sec
Velocity
v1
v2
Strain rate
Time
SPECKLE-TRACKING ECHOCARDIOGRAPHY:
Comprehensive assessment of myocardial deformation
Longitudinal deformation
Base
LONGITUDINAL
Circumferential
deformation
Radial
deformation
Radial
deformation
• Torsion
TORSION
Azienda Ospedaliera
Universitaria - Ferrara
CIRCUMFERENTIAL
Apex
Torsional deformation
RADIAL
Napoli 2011
Speckle-Tracking Echocardiography 2D
Global Longitudinal strain
3D RT-STE - 4D Global Longitudinal Strain
Limiti e Potenzialita’
HF PATHOPHYSIOLOGY
Normal
HFrEF
HFpEF
Transthoracic lung ultrasound reveals multiple sonographic B-lines (ultrasound lung comets,
white arrows) in a patient with acute pulmonary oedema.
Patrizio Lancellotti et al. Eur Heart J Cardiovasc Imaging 2015;16:119-146
Integrazione delle informazioni con
ultrasuoni con parametri clinici e
bioumorali per guidare interventi
terapeutici