Coronary flow imaging

Coronary Flow Imaging

Demo Teaching – Cardiac Application

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Coronary Arteries

Heart Segmentation

Scan Views

Example

Next arguments

Coronary Arteries

AP

AOa

VCs

VCi

Vene P

LCx

LADPDA

LCx

PDA

LCx: Left Circumflex ArteryLAD: Left Anterior DescendigPDA: Posterior Descending Artery

Right CA Left CA

Heart Segmentation: Segments in LAX and SAX

Heart Segmentation: Segments in 4Ch and 2Ch

Doppler: CFR quantification

Coronary Arteries Origin

PA

IVC

SVC

Coronary Arteries Origin

Aortic Valve

RA

RV

Papillary muscles

LR N

Chordae Tendinae (Heart

Strings)

The role of Heart Strings is to prevent

the flaps reversal into the right atrium


Images and data courtesy of Prof. Rigo

AORTA

Pulmunary

AURICOLA

Prox LAD

Mid LAD

Doppler: Quantification of Coronary Flow Reserve (CFR) for LAD (Left Anterior Descending Coronary Artery)

Ultrasound findings of coronary arteries: LAD (Prox-Mid tracts)

Normal valuesMFV=35±9 cm/s

Rigo, Cardiovascular Ultrasound 2008


Feasibility 78% pts

LAD I = Proximal Tract

44 cm/s


LAD II = Medial Tract

36 cm/s


Doppler: Quantification of Coronary Flow Reserve (CFR) for LAD (Left Anterior Descending Coronary Artery)

Ultrasound findings of coronary arteries: LAD (Mid-Distal tract)

Lad: mid-distal tract

Feasibility 98% ptsNormal values

MFV=25±7 cm/s

Rigo, Cardiovascular Ultrasound 2008


LAD III = Distal Tract

31 cm/s


Doppler: Quantification of Coronary Flow Reserve (CFR)

TTD NON INVASIVE

LV

94 cm/s

LAD I

LAD III

Doppler: Quantification of Coronary Flow Reserve (CFR)Example of Pathological coronary flow pattern (stenosis)

Rigo et al ESC 2010

Proximal LAD

42 cm/s

35 cm/s

Distal LAD

MID LAD

94 cm/s


Coronary Flow Reserve (CFR) is the study of coronary flow velocity during a Stress examination

Flow velocity is measured on the Left Anterior Descending Coronary Artery (LAD) within the 3 segments: (Proximal, Medial and Distal)

during Rest, Dipyridamole Stress and Recovering Phases.

Example of pathological Coronary Flow Pattern (Stenosis)The customer needs to verify the coronary flow during the REST and

after the STRESS



Reserve is performed using:

1) Phased Array probe

2) Color Doppler (for the visualization of the Coronary Artery Flow)

3) Pulsed Wave Doppler (for the Coronary Flow analysis) and Clinical Protocol of Dipyridamole Stress Echocardiography


Stress Test with CRF (Coronary Flow Reserve)

Stress Test with CRF (Coronary Flow Reserve)


The assessment of Coronary Blood Flow characteristics is meaningful also regarding basal cardiac activity without any

externally induced cardiac stress Typical Left Anterior Descending Coronary Artery blood flow.

Velocities at basal cardiac activity can be seen in the following image:


MyLab60/70/ClassC/Twice Preset – Cardio & CFI

Preset Cardio

Adulti - 8.08.0 CFI Cardio

Based

B-Freq TEI - Gen-M TEI - Gen-M

Angle 75°/70° 75°/70°

Gray Map 7 7

Dynamic Range 11/9 9

Compres. Dyn. 2 2

Density 1 1

Foc. 1 1

Enhance 2 2

Power 100% 100%

Persist 1/2 1/2

Sview on on

X-View 4-3-6 4-3-6

Post-ProcessingSlope 50 - Rej 20

- Sat 240Slope 50 - Rej 20

- Sat 240

Scan fast fastColorize 0/10 0/10

Range Dyn 10 10Gray Map 7 7

Compr. Din 2 2

CFM-Freq 2,3/2,5Mhz 2,8/2,5HD CFM 1 0

Filter 2 2Density 1 1

Col. Map VV13VV13 (Color Priority

- 255)Smooth Med MedPersist 3 8

PRF 3,5K/4.0hz 1.5/2Khz

Format smallPW-Freq 2.5 2.5CW-Freq 2.1 2.1

PRF6.0 (for CW about

2.0m/s)Scale about 0.60 m/s

- 1.25 m/sColorize 0 8

Sample V. 4 10Gray Map 5/6 6

Range Dyn 8 \ 5 cw PW 8/5 CWFilter 300 (600 CW) 100/150Scan Med Fast

Ris FFT Med\Max cw Med\Max cw

Thank you

Demo Teaching – Cardiac Application

US Marketing

Coronary flow imaging

Health & Medicine

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