euroecho2010 dilated cardiomyopathy diagnosis moya 550
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Euroecho2010 Dilated Cardiomyopathy Diagnosis Moya 550TRANSCRIPT
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DILATED CADIOMYOPATHY AND DILATED CADIOMYOPATHY AND
JL Moya JL Moya MurMur
DIFFERENCIAL DIAGNOSIS DIFFERENCIAL DIAGNOSIS
Hospital Ramn y CajalHospital Ramn y CajalMadrid. Madrid. SpainSpain
I do not have any conflict of interest
EUROECHO CONGRESS - COPENHAGEN -TEACHING COURSE 2010
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Classification of the Classification of the cardiomyopathiescardiomyopathies: a position statement from the : a position statement from the European Society of Cardiology Working Group on Myocardial and European Society of Cardiology Working Group on Myocardial and DericardialDericardial DiseasesDiseases. 2008. 2008
Familial Non Familial
DCM
Evidence of LV dilationImpaired LV contraction.
Coronary artery diseaseCoronary artery diseaseHypertensionValvular heart disease
EUROECHO CONGRESS - COPENHAGEN -TEACHING COURSE 2010
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INITIAL EVALUATION AND DIAGNOSIS
PROGNOSTIC EVALUATION
GUIDING AND MONITORING TREATMENTGUIDING AND MONITORING TREATMENT
EUROECHO CONGRESS - COPENHAGEN -TEACHING COURSE 2010
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Analysis of morphology and systolic functionAnalysis of morphology and systolic function
LV spherical dilationLV spherical dilationNormal or reduced wall thicknessNormal or reduced wall thicknessPoor wall thickeningPoor wall thickeningPoor wall thickeningPoor wall thickeningDyssynchronyDyssynchrony movementmovementAbnormal systolic parametersAbnormal systolic parametersFour chambers enlargementFour chambers enlargementFour chambers enlargementFour chambers enlargement
LVEDV > 112%; EF < 45%LVEDV > 112%; EF < 45%
EUROECHO CONGRESS - COPENHAGEN -TEACHING COURSE 2010
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Analysis of morphology and systolic function
Mitral Annulus Peak Systolic Mitral Annulus Peak Systolic VelocityVelocity
Mitral Annulus Peak Systolic Mitral Annulus Peak Systolic DisplacementDisplacement
SphericitySphericity indexindexmyocardial performance index myocardial performance index
dPdTdPdTPeak Systolic StrainPeak Systolic Strain
EUROECHO CONGRESS - COPENHAGEN -TEACHING COURSE 2010
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Analysis of diastolic function and filling pressure.Analysis of diastolic function and filling pressure.
TDI PVF LA vol.TDI PVF LA vol.Mitral filling patternMitral filling pattern
Recommendations for the evaluation of left ventricularevaluation of left ventricular diastolic function by echocardiography.
Nagueh SF Eur J EchocardiogrNagueh SF. Eur J Echocardiogr. 2009 Mar;10(2):165-93.
EUROECHO CONGRESS -COPENHAGEN - TEACHING
COURSE 2010
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Analysis of diastolic function and filling pressureAnalysis of diastolic function and filling pressure
Dokainish H, Circulation. 2004 109(20) 2432 92004;109(20):2432-9.
EUROECHO CONGRESS -COPENHAGEN - TEACHING
COURSE 2010
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Analysis of Analysis of valvularvalvular function: mitral regurgitationfunction: mitral regurgitationLV remodelingLV remodeling
posterior papillary Muscle displacement
Tethering of theMitral leaflet
excess of
III b , Carpentier valvular Tenting
Annulus dilation
Dyssynchrony
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TentingTentingLV remodelingLV remodelinggg
PPMPPM despdesp
EROERO
PPM PPM despdesp
YiYi Ci l tiCi l ti
PPM PPM despdesp
YiuYiu. . CirculationCirculation. . 2000;102:14002000;102:1400--1406 1406
tentingtentingT tiT tiTentingTenting
M.R. M.R. severityseverity
SadeghpourSadeghpour J J CardiothoracCardiothorac SurgSurg. . 2008; 3: 54 2008; 3: 54
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Analysis of pulmonary pressure and right Analysis of pulmonary pressure and right ventricular functionventricular function
PSPCATE
DOPPLER
Kaul S, JM. Am Heart J 1984;107:526531.
EUROECHO CONGRESS - COPENHAGEN -TEACHING COURSE 2010
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IDIOPHATIC HCM
SARCOIDOSIS CHAGASAMYLOIDOSISAMYLOIDOSIS
Thomas DE. European Journal of Echocardiography (2009) 10, iii15iii21
EUROECHO CONGRESS - COPENHAGEN -TEACHING COURSE 2010
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Left ventricular nonLeft ventricular non--compactioncompaction
Family screening200 patients with cardiac failure
anticoagulation,
protective device
24% satisfy one criteria
5 /60 (8%) control subjects protective device therapy
5 /60 (8%) control subjects satisfy some criteria.
Kohli. Eur Heart J 2008; 29:8995
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INITIAL EVALUATION AND DIAGNOSIS
PROGNOSTIC EVALUATION
GUIDING AND MONITORING TREATMENTGUIDING AND MONITORING TREATMENT
EUROECHO CONGRESS - COPENHAGEN -TEACHING COURSE 2010
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E F
Systolic function Systolic function
TDIE.F. TDI
Mitral annulus systolic velocity(TDI)(TDI)
SERRAY JACC 1986;7:729Wang JACC 2003, 41: 820-826
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SphericitySphericity indexindex DyssynchronyDyssynchrony
L
D
S h i it i d L / DSphericity index = L / D
Cho GY JACC 2005;46:2237 43Tischler. JACC. 1993;22,3, 751-757
Cho GY,. JACC 2005;46:2237 43.
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DIASTOLIC MITRAL FILLING
Diastolic function Diastolic function DIASTOLIC MITRAL FILLING
Mller JACC, 2000; 36:1841-1846Alameda M , Moya, JL Rev Esp Cardiol 2002;55(4):372-82
Campolla. JACC 38,, 2001, 1675-1684Alberto Garca-Lled, Jos L. Moya, Rev Esp Cardiol. 2005;58(9):1029-36
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Hillis GS, J Am Coll Cardiol 2004;43:360 7.Beinart J Am Coll Cardiol, 2004; 44:327-334,Mller Circulation. 2003;107:2207
The prognostic capacity of echo increases asSystolic function , Diastolic function Filling pressures are introduced in the model
LAV increment the prognostic information of Clinical , systolic and diastolic function
Filling pressures, are introduced in the model
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Mitral regurgitation. Mitral regurgitation. Ischaemic dilated cardiomyopathy
Asynptomatics.Ischaemic dilated cardiomyopathy
Grigioni et al. Circulation 2001; 103:1759-64 Grigioni et al. JACC 2005,45(2)260-7.
i h i dil t d di thTenting area is an independent predictor of mortality and hospitalizations in patients with NICMP and FMR.
non-ischaemic dilated cardiomyopathy
Karaca O, Eur J Heart Fail. 2010 Nov 23.
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Right ventricular function and pulmonary pressureRight ventricular function and pulmonary pressure
Vel de IT < 2,5 m/sg
Vel de IT > 2,5 m/sg
Stefano Ghio. MD Am J Cardiol. 2000 Apr 1;85(7):837-42.
Abramson Ann Int Med 92:116:888
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INITIAL EVALUATION AND DIAGNOSIS
PROGNOSTIC EVALUATION
GUIDING AND MONITORING TREATMENTGUIDING AND MONITORING TREATMENT
EUROECHO CONGRESS - COPENHAGEN -TEACHING COURSE 2010
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Medical Therapypy
Mitral repairMitral repair
Anticoagulation Therapy
Resynchronization Therapy
ICD Therapy
EUROECHO CONGRESS - COPENHAGEN -TEACHING COURSE 2010
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F C IIIF C III--IVIVF.C. IIIF.C. III IVIVEF < 35% EF < 35%
QRS > 120msQRS > 120msQRS > 120msQRS > 120ms
?%?%NO THERAPYNO THERAPY
2020--30% 30% RST THERAPYRST THERAPY
NO RESPONSE NO RESPONSE NO RESPONSENO RESPONSE
ECHOCARDIOGRAPHY
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SeptSept.
L. Wall
BaxBax JJ, Am J JJ, Am J CardiolCardiol 2003; 92:12382003; 92:1238
SLWD 60SLWD > 60 ms
> 140 ms
SPWMD > 130 ms LVFT < 40%
> 140 ms
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PROSPECTPROSPECT
No single mechanical echocardiographic measure of dyssynchrony may be recommended to improve patient selection for resynchronization therapy.
Method to determine the mechanical dyssynchrony needs further development.
Chung Circulation 2008; 117:2608
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1 2
3 4
WE NEED A METHODWE NEED A METHOD
--DetectDetect dyssynchronydyssynchrony and respondersand respondersDetect Detect dyssynchronydyssynchrony and respondersand responders--Low variabilityLow variability--Better results than obtained with QRS durationBetter results than obtained with QRS duration--With results confirmed in prospective studiesWith results confirmed in prospective studiesp pp p
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2010 F d U d t f ESC G id liG id li2010 Focused Update of ESC Guidelines Guidelines on device therapy in heart failure. on device therapy in heart failure. European Heart Journal (2010) 31, 26772687
EUROECHO CONGRESS - COPENHAGEN -TEACHING COURSE 2010
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For Simpsons rule, Bland-Altman limits of agreement p , g(95% CI) ranged from LVEF 7% to 25% (median 18%);
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Why do no respond?Why do no respond?
Improper patient selection Improper patient selection.
No mechanical asynchrony.
Improper position the electrodeImproper position the electrode.
Advanced state of cardiomyopathy
/incorrect AV/VV delay optimization
Dysfunction device,
displacement of the cable.
Arrhythmias, spontaneous or mediated by the PM
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How to optimize dyssynchrony with echo?
1.- program different AV or VV delays
septal2.- analyze their repercussion in:
-SYNCHRONYLat. Wall
SYNCHRONY-SYSTOLIC FUNCTION: AORTIC VTI-DIASTOLIC FUNCTION: MITRAL FILLING.
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RV20LV LV20RV LV40RVLV00RVbasal
TDI vel
TTTT
Strain
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Kedia. Am J Cardiol 2006;98:780 785
Boriani Am Heart J 2006;151:1050-8. (RHYTHM II )
Vidal B, Am J Cardiol 2007;15:1002
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ASE EXPERT CONSENSUS STATMENT
Current studies have shown thas subsets of patients do acutely benefit from p yV-V optimization, but long term benefit has yet to be determined
GorcsanGorcsan III JASE 2008;21: marzo: 191III JASE 2008;21: marzo: 191--245245
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Echocardiography is essential in patients with SD and DCM:
-Describe the typical features and associated findings of patientswith Dilated Cardiomyopathy.
-Assess systolic and diastolic function, mitral regurgitation, and RV function.
- Identify echo marker of adverse prognosis
- is useful in guiding and monitoring therapeutic management.