Les indices de déformation myocardique en 3D/4D pour évaluer la fonction myocardique régionale...
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Transcript of Les indices de déformation myocardique en 3D/4D pour évaluer la fonction myocardique régionale...
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