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Confronto Hard: La deformazione miocardica, il twist, il rocking e il rock and roll, sono solo musica? Pro: G. Tonti Con

Confronto Hard: La deformazione miocardica, il twist, il rocking e il rock and roll, sono solo musica? Pro: G. Tonti Contro: D. Mele. Napoli 2011. Ejection fraction: a measure of desperation? Manisty CH, Francis DP. Heart 2008; 94:400-401.

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Confronto Hard: La deformazione miocardica, il twist, il rocking e il rock and roll, sono solo musica? Pro: G. Tonti Con

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  1. Confronto Hard: La deformazione miocardica, il twist, il rocking e il rock and roll, sono solo musica? Pro: G. Tonti Contro: D. Mele Napoli 2011

  2. Ejection fraction: a measure of desperation? Manisty CH, Francis DP. Heart 2008; 94:400-401. “Nowadays, EF is surely only justified as a sole index of cardiac function in situations of desperation when there are no available quantities calibrated in physical units.” “We hope that one day we will no more likely to classify patients with heart failure by EF than we classify patients with cancer by hemoglobin level.” Napoli 2011

  3. THE MYOCARDIAL DEFORMATION Napoli 2011

  4. Napoli 2011

  5. GLS cut-off value= -12% Napoli 2011

  6. Napoli 2011

  7. Effects of global longitudinal strain and total scar burden on response to CRT in patients with ischaemic dilated cardiomyopathy D’Andrea A et al. Eur J Heart F 2009; 11: 58-67 Average Global longitudinal strain (GLS) correlates closely with MRI total scar burden (r=0.64, P<0.001). GLS and radial intraventricular dyssynchrony were powerful independent determinants of response to CRT. Napoli 2011

  8. Napoli 2011

  9. AN EXAMPLE OF CLINICAL APPLICATION Napoli 2011

  10. Napoli 2011

  11. Before trastuzumab After 2 months Napoli 2011

  12. Acute Cardiac Functional and Morphological Changes After Anthracycline Infusions in Children Ganame et al, Am J Cardiol 2007;99:974 –977 Individual peak radial systolic ε before and after anthracyclines (ANT). A  in peak systolic ε was noted in all patients after the 1st dose of ANT; in some, progressive was seen after the 2nd and 3rd doses. Ten patients showed values < normal limits (50%) after the 3rd dose. Gray area, normal values  1 SD. Napoli 2011

  13. REGIONAL MYOCARDIAL DEFORMATION IN CANCER THERAPY Author Journal Year Takenaka et al. J Cardiol 2001 Mercuro et al. The Oncologist 2007 Mantovani et al. The Oncologist 2008 Ganame et al. Am J Cardiol 2007 Ganame et al. J Am Soc Echocardiogr 2007 Jurcut et al. J Am Soc Echocardiogr 2008 Hare et al. Am Heart J 2009 Cheung et al. Heart 2010 Ho et al. Heart 2010 Karabay et al. Cardiology 2010 Tsai et al. Am J Cardiol 2011 Sawaya et al. Am J Cardiol 2011 Napoli 2011

  14. THE ROCKING Napoli 2011

  15. Napoli 2011

  16. Speckle-tracking echo may help recognizing transmural scar segments at a regional level Napoli 2011

  17. Carasso et al, J Am Soc Echocardiogr 2009;22:242-250. PRE CRT CRT Napoli 2011

  18. THE TWISTING Napoli 2011

  19. LV apex Rotation & Twisting LV base Normal Systolic Heart failure Napoli 2011

  20. Normal Heart failure Napoli 2011

  21. Sade LE et al, AJC 2008; 101:1163-1169 Napoli 2011

  22. Napoli 2011

  23. Napoli 2011

  24. Napoli 2010 Napoli 2011

  25. Speckle Tracking and Diastolic CHF (Wang J et al,Eur Heart J2008;29:1283-1289) Twist VS (gradi) Strain Circonf. (%) Strain radiale (%) Strain Longitud. (%) Preserved EF CHF Controls Systolic CHF Napoli 2010 Napoli 2011

  26. n Normal Systolic HF Diastolic HF C.pericarditis Napoli 2010 Napoli 2011

  27. Napoli 2010 Napoli 2011

  28. THE (current) FUTURE Napoli 2011

  29. Napoli 2010

  30. Napoli 2011

  31. 4D Longitudinal Strain Napoli 2010

  32. 4D Circumferential Strain Napoli 2010

  33. 4D Area Strain Area strain shows % of change of an area from a mid-myocardial layer. It reflects a combination of longitudinal and circumferential strain. Napoli 2010

  34. 4D Radial Strain (VolC) 4D Radial Strain VolC is estimated from the area strain using an assumption of volume conservation. The parameter is therefore called “Radial Strain (VolC)”. Napoli 2010

  35. DEFORMATION IMAGING • Meaningfulclinical information • Betterthanejectionfractionforprognosis • Helpsidentifyingsubclinicaldysfunction • Helpsunderstandingpathophysiology and decisionmaking • Promisingcomprehensive 3D evaluation Napoli 2011

  36. Napoli 2011

  37. Napoli 2011

  38. I TESTIMONIALS Napoli 2011

  39. Napoli 2011

  40. Napoli 2011

  41. Deformation, what else? Napoli 2011

  42. Al congresso SIEC: • 15 RELAZIONI • 40 ABSTRACT • sullo speckle tracking • LA SIEC CI CREDE! Napoli 2011

  43. GLI AUTORI NAPOLETANI Ascione Caso Citro D’Andrea Di Salvo ecc… Galderisi Martiniello Maurea Palmieri Severino ecc… Napoli 2011

  44. NAPOLI CI CREDE Napoli 2011

  45. DEFORMATION IMAGING • Non c’è tecnica senza limiti, che vanno superati con un atteggiamento non distruttivo ma costruttivo. • I limiti vanno usati per capire come applicare al meglio una tecnica, non per distruggerla. • Occorre andare incontro al futuro, per evitare che il futuro ci colga di sorpresa. Napoli 2011

  46. Eco 3D ed eco speckle tracking possono essere il futuro dell’ecocardiografia. Sta a noi fare in modo che questo accada. Napoli 2011

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