Download Lo studio della funzione ventricolare sinistra: stiamo entrando in una

Lo studio della funzione ventricolare
sinistra:
stiamo entrando in una nuova era?
_
Trieste
San Daniele del Friuli
Olga Vriz
Left Ventricular Performance:
-
Fractional Shortening
LVEF
Diastolic Function
Global Longitudinal Strain (GLS)
- LV Torsion
Forces that oppose Left Ventricular ejection
- Ventricular arterial coupling
Blood flow
-Changes in Blood flow direction in cardiac chambers
FS= LVIDD-LVIDS/LVIDDx100 ( vn 25-45%)
Inner Shell= ([LVIDD+SWTD/2+PWTD/2]3-LVIDD3+LVIDS3)1/3-LVIDS
MWFS= ([LVIDD+SWTD/2+PWTD/2]-[LVIDs+inner shell)]/
(LVIDD+SWTD/2+PWTD/2)x100 (vn 14-23%)
EF ( biplane method of disks summation- Modified Simpson’s rule) (vn 52-74%)
Basic Diastolic Survey
MV inflow
 DTI
 Pulmonary veins
 Left atrial volume index

Basic Diastolic Survey
Global Longitudinal Strain
(GLS)=
myocardial deformation
Peak value of 2D longitudinal
speckle tracking derived
strain (%).
NV -20%
Angle
independent
Established
prognostic value
Vendor dependent
546 pts
584 pts
Counter Clockwise
rotatoin
Clockwise rotatoin
LV twisting motion is due to contraction of obliquely oriented
fibers in the subepicardium, which course toward the apex in
the counterclockwise spiral
Untwisting starts in late systole but mostly occurs during the
IVRT and largely finishes at the time of the MV opens.
LV twist plays an important role in systolic function and
untwisting in diastolic function contributes to LV filling
through suction generation
VENTRICULAR-ARTERIAL COUPLING
 Effective arterial elastance Ea (Ea 2.2+/-0.8
mmHg/ml). Can be considered the net
arterial load that is imposed to the LV
 Left ventricular systolic elastance (or end
systolic stiffness) Ees is a index of
contractility (Ees 2.3+/-1.0 mmHg/ml)
Ea/Ees=1
ASS 4 Medio Friuli –Servizio di Cardiologia– Ospedale San Antonio - San Daniele del Friuli
Am J Med. 1991 May 29;90(5B):14S-18S.
Coupling
between the heart and arterial
system in heart
VENTRICULAR-ARTERIAL
COUPLING
failure. Sasayama S, Asanoi H.
ASS 4 Medio Friuli –Servizio di Cardiologia– Ospedale San Antonio - San Daniele del Friuli
Ea: (0.9XSBP/SV)
Ees = (DiastBP-(ENdest*SystBP*0.9)) / (SVcalculated*ENdest)
TND = PreEjection Time/TotalSystolic Time
ENdavg = 0.35695 + (-7.2266 +(74.249 +(-307.39 +(684.54 +(-856.92 + (571.95 159.1*TND)*TND)*TND)*TND)*TND)*TND)*TND
ENdest = 0.0275 -0.165*(EF/100) +0.3656*(DiastBP/(SystBP*0.9))
+0.515*Endavg
Ea/Ees=1
End= normalized elastance
JACC 2001
ASS 4 Medio Friuli –Servizio di Cardiologia– Ospedale San Antonio - San Daniele del Friuli
Wave
Intensity
(WI)
ASS 4 Medio Friuli –Servizio di Cardiologia– Ospedale San Antonio - San Daniele del Friuli
Wave intensity (WI)
WI = (dP/dt) ｘ (dU/dt)
WI = (dP/dt) ｘ (dU/dt)
＋
＋
＋
W1
＋
－
W1
W2
W2
－
Wave intensity (WI)
 W1 – first peak, in early
ejection
Its magnitude increases with
cardiac contractility
≈ LVmax dP/dt
max dP/dt2]/ρc
 W2 – seccond peak, late
systole to isovolumic
relaxation, related to the
ability of LV to actively stop
aortic blood flow
≈ time constant of LV
relaxation (tau)and –dP/dt
max dP/dt]2ρc
Heart and Vessels 2014
 Echocardiographic Image velocity
(contrast agent)
 Combined color-Doppler/spackle
tracking
Changes of flow through the heart
chambers and appearance of VORTICES:
regions of accumalated VORTICITY
Vorteces plays an important role in
normal cardiac function:
-
Keeping blood in motion
Preserving momentum
Avoiding excessive dissipation of
energy
Facilitating inflow into ventricle
Redirecting flow towards the aorta
Stiamo entrando in una nuova era
della comprensione della funzione del
Ventricolo Sinistro