Les indices de déformation myocardique en 3D/4D pour évaluer la fonction myocardique

régionale

Erwan DONALCardiologie et CIC-IT 804, LTSI INSERM U 647

Congrès du CNCF, Paris. Octobre 2009

Longitudinal function:

contractility from the base to the apex

Radial function:

contractility from the outer to the center of the LV cavity

Circonferential &Torsion

Complexity of LV Anatomy and Functions

What are the Speckle providing?

LV

leafletleaflet

Frame 1 Frame 2

Longitudinal Radial

CirconferentielV. Normales:

•LONG -20%

•Circ -20%

•Radial 40%

L’étude des déformations

Différencier la Nécrose sous-endocardique de celle trans-murale.

• Série de 80 patients. ECHO/IRM

Chan et al. JACC 2006: 48: 2026

0

5

10

15

20

25

30

35

40

circonf' Longit' Radial

transmural

Sous endocard

normal

% d

e d

éfo

rmat

ion

télé

dia

stol

e –

télé

syto

le /

télé

dias

tole

nsP<0.01

2D Speckle Tracking

Tracking image after image

3D Speckle Tracking

The speckle motion is not 2D but 3D

Strain components in a segment

CircumferentialStrain

CircumferentialStrain

Longitudinal

Strain

RadialStrain

Twist

AreaStrain

3D Speckle Tracking

3D Longitudinal strain

3D Speckle Tracking 3D Radial strain

3D Speckle Tracking3D Circumferential strain

Assessment of Torsion / Rotation

Parasternal short axis view

at the level of the mitral leaflets at the apex

Parametric imagingParasternal short axis view

at the level of the mitral leaflets at the apex

Assessment of Torsion / Rotation

basebase apexapex

Ro

tatio

n V

elo

city o

f Ro

tatio

n

Ro

tatio

n V

elo

city o

f Ro

tatio

n

Counter clockwise Rotation

ClockwiseRotation

ClockwiseRotation

Counter clockwise Rotation

3D Speckle Tracking

3D rotation strain

Area change

3D Speckle Tracking

3D Speckle TrackingArea strain calculation

Radial = L+SAX

2D, Visual assessmentM Mode 2D Strain

Longitudinal = APICAL

2D, Visual assessment

TDIM-Mode

2D Strain

Atrio-ventricularDyssynchrony Inter-ventricular

Dyssynchrony Intra-ventricularDyssynchrony

Multiparametric Algorithm

Lafitte, Habib, Donal. Eur H Journal 2009

Great Interest in a reproducible, easy and Feasible 3D assessment of dyssynchrony

Clinical applicationVD pace only CRT on

Global area strain -13,8% Global area strain -18,6%

Clinical applicationGlobal Performance Index (GPI)

Global Performance Index

-50

-45

-40

-35

-30

-25

-20

-15

-10

-5

0

0 5 10 15 20 25 30

1

Global Performance Index

-50

-45

-40

-35

-30

-25

-20

-15

-10

-5

0

0 5 10 15 20 25

1

VD pace only CRT ON

We are at the Beginning

►Great Expectation in regard to that UNIQUE

combination of a 3D-volumetric acquisition and

a 3D capability to track the speckle within the

myocardium and the endocardium.

► Many facilities for the post-treatment

Experimental and clinical validations are

still necessary.

Conclusion

2D Speckle Trackingautomatic detection of LV borders

2D Deformation

3D-Vectors (displacement)

3D3D displacementMany post-treatments easy to apply

Area Change