damien coisne 1jcp 19 sep 2009 http:
TRANSCRIPT
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Damien Coisne
1JCP 19 Sep 2009
Http://www.coeurplus.fr
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tissue velocity imaging =621
tissue velocity imaging heart =303
strain echo imaging =48
strain echo imaging heart =14
JCP 19 Sep 2009 2
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Les différentes méthodes d’acquisition: TVI, Speckle trcking
Les valeurs normales, la reproductibilité La fonction systolique globale
longitudinale: GLS/AFI Strain et la viabilité, IDM transmural
JCP 19 Sep 2009 3
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4JCP 19 Sep 2009
2D Speckle trackingTVI
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5JCP 19 Sep 2009
Sur base de champs de vitesseTVI
S
EA
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Time integral
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Grande sensibilité aux variations rapides du fait de la haute cadence d’analyse de la vitesse.
Plus adapté au Strain Rate (dérivée temporelle de la déformation)
Volume d’échantillonnage relativement faible. VD, paroi auriculaire, zones focales distales
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8JCP 19 Sep 2009
Sur base de suivi de particules: Speckle Tracking
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Etude directe de la déformation, pas d’intégration de la vitesse.
Nécessité de cadence d’image minimale > 60i/s
+ Résolution spatiale Echogénicité. Adapté au zones proximales. Faible variabilité sauf pour strain radial
( parallèle à l’incidence des US)
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Strain. Paramètre de fonction systolique globale
Strain rate. Relation étroite à l’inotropisme
JCP 19 Sep 2009 10
STRAIN ET STRAIN RATE
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JCP 19 Sep 2009 11
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12JCP 19 Sep 2009
Mini 50 I/sAngle d’explorationRésolution spatialeHarmonique
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Timing valvulaires
13JCP 19 Sep 2009
OM FMQ OAo
FAo
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Global strain longitudinal: - 13.5 %
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Strain rate: -0.72
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Accès à la déformation radial et circonférentielle
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Radial
Circ
-22%
-65% Résolution spatiale des zones lat et septales!!!
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FEVg est un paramètre incontournable dans la prise
de décision quotidienne en cardiologie.
La FEVG en échographie (et ailleurs !!!) souffre
d’imperfection liées à la méthode de mesure.
GLS, paramètre particulièrement reproductible,
cherche à apporter une information supplémentaire à
celle de la FEVG.
JCP 19 Sep 2009 22
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GLS et FEVG
GLS et sportifs
GLS et ins cardiaque
GLS et valvulopathie
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JCP 19 Sep 2009 24
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JCP 19 Sep 2009 25
Feasibility of strain measurements. Tracking quality 3 was obtained in 3,067 segments and 192 patients(79%).Tracking was best in the septum and inferior wall and worst in the anterolateral walls, especially in the apex.
Faisabilité
Qua
lité
du s
trai
n
Qualité: 1 optimal, 3 non analysable
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GLS 16 segments
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Objectif: Evaluer la valeur du GLS dans l’évaluation de l’étendue de la nécrose et le pronostic. Comparée à la FEVg
N: 42, IDM thrombolysés, GLS: moyenne de SL/16 (AFI)
ROC analysis: LV global strain vs. LVEF Detection large MI >22%
Time-point AUC Sens (%) Spec (%) Cut-off value (%)
Acute GLS 90 88 83 -16,5
LVEF 75 88 60 52
Discharge GLS 95 88 94 -16,0
LVEF 90 88 74 51
GLS plus reproductible, meilleure corrélation entre GLS et la taille de l’idm (IRM)
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JCP 19 Sep 2009 28
Relation Between Global Left Ventricular Longitudinal Strain Assessed with Novel Automated Function Imaging and Biplane Left Ventricular Ejection
Fraction in Patients with Coronary Artery DiseaseDelgado V JASE 2008
Méthode automatique de calcul du GLSBasé sur 3 incidences apicalesMoyenne des valeurs de tous les segments analysables
AFI: automated function imaging
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GLS (6seg) : - 18.9 %
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GLS (6)=-15.6%
GLS (6)=-20.8%
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JCP 19 Sep 2009 31
Relation Between Global Left Ventricular Longitudinal Strain Assessed with Novel Automated Function Imaging and Biplane Left Ventricular Ejection Fraction in Patients
with Coronary Artery DiseaseDelgado V JASE 2008
N= 220, 20 témoins, 99 IDM, 123 ins card sévère Méthode . GLS par AFI
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V Richand Am J Cardiol 2007;100:128 –132
29 PSP, 17 control,Pseudo AFI: GLS sur 13 segments ( et 4 cav)
32JCP 19 Sep 2009
GLS plus faible, « compensé » par radial et circ plus élevé
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JCP 19 Sep 2009 34
Y Cho, T Marwick .J Am Coll Cardiol 2009;54:618–24)
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JCP 19 Sep 2009 35
Y Cho, T Marwick .J Am Coll Cardiol 2009;54:618–24)
Altération de la fn long est plus précocel’altération de la fonction circ plus en relation avec le pronostic
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Cur off Value GLS;1.8%
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Patient âgé de 63 ans ayant présenté une décompensation cardiaque d’origine indéterminée il y a 6 mois
Bilan écho . IM sévère , DTS à 45 et FEVG à 52% Revu 3 mois après . IM grade2 , SOR à 0.19, FR<30%, VG; 58/34, FEVG 53%, Paps
à 35 mmHg. pauci symptomatique coro normale.. Echo à l’exercice. 75 watts, pas de dyspnée, SOR 0.19 à 0.39 cm2, Paps 35 à 57
mmHg,
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GLS et RAO
39JCP 19 Sep 2009
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JCP 19 Sep 2009
65 Rao serrés asymptomatiques vs. témoins (FEVG=64%)Age moyen 70 ans
Repos: GLS : -17.8 vs. -21.1% segment basal: -12.4 vs -18.4%
Impact of impaired myocardial deformations on exercise tolerance prognosis in patients with asymptomatic aortic stenosis
Stephane Lafitte, Matthieu Perlant, Patricia Reant, Karim Serri, Herve Douard,Anthony DeMaria, Raymond Roudaut
40
Gradient base apex
Pas de modification des strain circ et rad
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JCP 19 Sep 2009
Impact of impaired myocardial deformations on exercise tolerance prognosis in patients with asymptomatic aortic stenosis
Stephane Lafitte, Matthieu Perlant, Patricia Reant, Karim Serri, Herve Douard,Anthony DeMaria, Raymond Roudaut
Rao intolérants effort: GLS repos: -14.7 vs. -19.3% basal: -10.7 vs -14.4%) (p< 0.05)
Prédiction intolérance effort: GLS global -18% Se 68% Sp 75%basal -13% Se 77% Sp 83%
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JCP 19 Sep 2009
↑°évènements cardiovasculaires
42
Impact of impaired myocardial deformations on exercise tolerance prognosis in patients with asymptomatic aortic stenosis
Stephane Lafitte, Matthieu Perlant, Patricia Reant, Karim Serri, Herve Douard,Anthony DeMaria, Raymond Roudaut
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JCP 19
Sep 2009
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Evolution du Strain longitudinal
Long strain global, basal= -9%
44JCP 19 Sep 2009
Long strain global, dobutamine= -12.1%
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Evolution de strain circonférentiel
Circ strain global, basal= -11.25%
45JCP 19 Sep 2009
Circ strain global, dobutamine= -13.5%
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46JCP 19 Sep 2009
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Myocardial Deformation Imaging Based on Ultrasonic Pixel Tracking to Identify Reversible Myocardial Dysfunction
Michael Becker, MD,*J Am Coll Cardiol 2008;51:1473–81
74 patients CMI, , MRI vs 2D strain, revasc: pontage (21), Dilat (34)
Rehaussement tardif: 5 niveaux Radial peak systolic strain
2D Strain
47JCP 19 Sep 2009
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Myocardial Deformation Imaging Based on Ultrasonic Pixel Tracking to Identify Reversible Myocardial Dysfunction
Michael Becker, MD,*J Am Coll Cardiol 2008;51:1473–81
22.9% 17.2% 11.4% 5.6%
Improvement of segmental function
0/ 25 / 50 / 75 / 100
48JCP 19 Sep 2009
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Strain Mapping by Speckle Tracking Echocardiography:A Novel Approach for Detailed Quantification of Infarct
Transmurality Irregularities After STEMIThomas M. Helle-Valle ACC 2009
3 SAX views, basal mid apical: 12 segments per view
LHE > 50% related to peak circ strain < -12%
Rotation max located on the border of the infarct zone
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Réponse biphasique +++50JCP 19 Sep 2009
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Strain circ basal , segment med VG paroi inf: 12.8 %51JCP 19 Sep 2009
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Strain circ paroi inf : 18.7, Strain moyen à 21.5%52JCP 19 Sep 2009
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L’imagerie de déformation entre dans sa phase de maturité.
L’apport du 2D Strain, est important car dans bon nombres de situations, la reproductibilité de la méthode est meilleure. Outil plus robuste mais laissant quelques indications au Strain TVI.
La GLS et AFI sont deux méthodes semi automatiques ont acquis leur légitimité dans bon nombre de situations cliniques.
Le seuil pathologique pour le GLS est à considérer en fonction de la pathologie examinée.
En ce qui concerne la pathologie ischémique,analyse régionale, la Strain circonférentiel semble être prometteur mais demande confirmation
53JCP 19 Sep 2009
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