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Erwan DONAL Cardiologie et CIC-IT 804, LTSI INSERM U 647

Congrès du CNCF, Paris. Octobre 2009. Les indices de déformation myocardique en 3D/4D pour évaluer la fonction myocardique régionale. Erwan DONAL Cardiologie et CIC-IT 804, LTSI INSERM U 647. Complexity of LV Anatomy and Functions. Longitudinal function:

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Erwan DONAL Cardiologie et CIC-IT 804, LTSI INSERM U 647

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  1. Congrès du CNCF, Paris. Octobre 2009 Les indices de déformation myocardique en 3D/4D pour évaluer la fonction myocardiquerégionale Erwan DONAL Cardiologie et CIC-IT 804, LTSI INSERM U 647

  2. Complexity of LV Anatomy and Functions Longitudinal function: contractility from the base to the apex Radial function: contractility from the outer to the center of the LV cavity Circonferential &Torsion

  3. Frame 1 Frame 2 What are the Speckleproviding? LV leaflet

  4. Longitudinal Radial • V. Normales: • LONG -20% • Circ -20% • Radial 40% Circonferentiel

  5. L’étude des déformations

  6. P<0.01 ns Différencier la Nécrose sous-endocardique de celle trans-murale. • Série de 80 patients. ECHO/IRM % de déformationtélé diastole – télésytole /télédiastole Chan et al. JACC 2006: 48: 2026

  7. 2D Speckle Tracking Tracking image after image

  8. 3D Speckle Tracking The speckle motion is not 2D but 3D

  9. Strain components in a segment Twist Area Strain Longitudinal Strain Radial Strain Circumferential Strain Circumferential Strain

  10. 3D Speckle Tracking 3D Longitudinal strain

  11. 3D Speckle Tracking 3D Radial strain

  12. 3D Speckle Tracking 3D Circumferential strain

  13. Assessment of Torsion / Rotation Parasternal short axis view at the level of the mitralleaflets at the apex

  14. Assessment of Torsion / Rotation Parametric imaging Parasternal short axis view at the level of the mitral leafletsat the apex

  15. Rotation Velocity of Rotation Rotation Velocity of Rotation base apex

  16. 3D Speckle Tracking 3D rotation strain Counter clockwise Rotation Counter clockwise Rotation ClockwiseRotation ClockwiseRotation

  17. 3D Speckle Tracking Area change

  18. 3D Speckle Tracking Area strain calculation

  19. Multiparametric Algorithm Atrio-ventricular Dyssynchrony Inter-ventricular Dyssynchrony Radial = L+SAX 2D, Visual assessment Intra-ventricular Dyssynchrony Longitudinal = APICAL • 2D, Visual assessment • TDI • M-Mode • 2D Strain Great Interest in a reproducible, easy and Feasible 3D assessment of dyssynchrony M Mode 2D Strain Lafitte, Habib, Donal. Eur H Journal 2009

  20. Clinical application VD pace only CRT on Global area strain -13,8% Global area strain -18,6%

  21. Clinical application Global Performance Index (GPI) VD pace only CRT ON

  22. We are at the Beginning Conclusion ►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.

  23. 2D Speckle Trackingautomatic detection of LV borders

  24. 2D Deformation

  25. 3D-Vectors (displacement)

  26. 3D displacementMany post-treatments easy to apply

  27. Area Change

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