scompenso cardiaco acuto e cronico: vecchi dogmi e nuovi ... bezante.pdf · patrizio lancellotti et...

Gian Paolo Bezante, MD, FACC

UOC Clinica di Malattie dell’Apparato Cardiovascolare

IRCCS Azienda Ospedale Università San Martino - Genova

V SESSIONE SCOMPENSO CARDIACO 2015

Genova, 13-14 Novembre 2015

L’ecocardiografia nello

Scompenso Cardiaco

Acuto e cronico:

vecchi dogmi e nuovi

trends.

DEFINITION

Heart failure (HF):

A clinical syndrome of inadequate oxygen

delivery to metabolizing tissues resulting from

any cardiac structural or functional impairment

of ventricular filling or ejection of blood

Eur Heart J 2012;33:1787-1847.

Circulation 2013;128:e240-327.

HF PATHOPHYSIOLOGY

Normal HFrEF HFpEF

Echocardiographic examination showing dilated cardiomyopathy and depressed left ventricular (LV) systolic function in a patient admitted for acute dyspnoea.

Patrizio Lancellotti et al. Eur Heart J Cardiovasc Imaging 2015;16:119-146

Real Time 3D Volume Measurements

Azienda Ospedaliera

Universitaria - Ferrara Napoli 2011

NORMALE ECOCARDIOGRAFIA 3D

systolic dyssynchrony index 11,22%

DISSINCRONO

systolic dyssynchrony index 0,62%

Echo Right Heart Catheterization

Schematic of pulse-wave Doppler of mitral inflow, color M-mode demonstrating mitral inflow propagation velocity, and tissue Doppler of the septal mitral annulus in normal diastolic

function and various stages of diastolic dysfunction.

J.K. Oh Eur J Echocardiogr 2007;8:4-14

Echocardiographic examination showing preserved left ventricular (LV) systolic function in a patient admitted for acute dyspnoea.


Diagnosis of heart failure with preserved left ventricular (LV) ejection fraction (EF) in a patient

presenting with dyspnoea.


Three patients with a similar degree of shortness of breath.


A: Parasternal long axis view from a middle-aged man with heart failure.


Copyright © 2006, The European Society of Cardiology

Practical approach to grade diastolic dysfunction by echocardiography.


Azienda Ospedaliera


RADIAL STRAIN DYSSYNCHRONY

Sample of regional longitudinal strain (APLAX: apical long-axis, 4CH: four-chamber view, 2CH: two-chamber view) a bulls-eye representation in a patient with cardiac amyloidosis.


Regional longitudinal strain (bulls-eye representation) in a patient with hypertrophic cardiomyopathy.


Fundamental and second harmonic signal separated by

filter

0 1 2 3 4 5

x 106

-20

0

20

40

60

80

20 40 60 80 100

50

100

150

200

250

300

350

400

450

Fundamental Signal from septum

Noise from LV cavity

2. harmonic -500 0 5000

50

100

150

200

250

-10 0 100

50

100

150

200

250

Second Harmonic TDI

Fundamental, f=1.67MHz

Second harmonic, f=3.33MHz

• Fundamental and second harmonic calculated from the same data set

• No significant noise difference

• Second harmonic TDI gives more aliasing.

Second Harmonic SRI

Fundamental, f=1.67MHz

Second harmonic, f=3.33MHz

• Fundamental and second harmonic calculated from the same data set

• Significant noise reduction when using the second harmonic frequency band

• Aliasing is not a problem due to small velocity differences

Myocardial velocity and strain rate with 300 frames/sec

Velocity

v1

v2

Strain rate

Time

Azienda Ospedaliera


SPECKLE-TRACKING ECHOCARDIOGRAPHY: Comprehensive assessment of myocardial deformation

Longitudinal deformation

Radial deformation

• Torsion

Radial deformation

Circumferential deformation

Torsional deformation

Apex

Base

LONGITUDINAL

CIRCUMFERENTIAL

RADIAL TORSION

Speckle-Tracking Echocardiography 2D

Global Longitudinal strain

3D RT-STE - 4D Global Longitudinal Strain

Limiti e Potenzialita’

HF PATHOPHYSIOLOGY

Normal HFrEF HFpEF

Transthoracic lung ultrasound reveals multiple sonographic B-lines (ultrasound lung comets, white arrows) in a patient with acute pulmonary oedema.


Integrazione delle informazioni con

ultrasuoni con parametri clinici e

bioumorali per guidare interventi

terapeutici

scompenso cardiaco acuto e cronico: vecchi dogmi e nuovi ... bezante.pdf · patrizio lancellotti et...

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