Azienda Ospedaliera Universitaria - Ferrara Trieste 2010 Confronto Hard: La deformazione miocardica,...

Azienda OspedalieraUniversitaria - Ferrara Trieste 2010

Confronto Hard:

La deformazione miocardica, il twist, il rocking e il rock and roll, sono solo musica?

Pro: G. TontiContro: D. Mele

Napoli 2011


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.”

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THE MYOCARDIAL DEFORMATION

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Azienda OspedalieraUniversitaria - Ferrara Trieste 2010Napoli 2011


GLS cut-off value= -12%


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.

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AN EXAMPLE OF CLINICAL APPLICATION

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Before trastuzumab

After 2 months

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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.

Acute Cardiac Functional and Morphological Changes

AfterAnthracycline Infusions in

ChildrenGaname et al, Am J Cardiol 2007;99:974 –

977

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REGIONAL MYOCARDIAL DEFORMATION IN CANCER THERAPY

Mercuro et al.

Mantovani et al.

Ganame et al.

Ganame et al.

Takenaka et al. J Cardiol 2001

Am J Cardiol 2007

J Am Soc Echocardiogr 2007

The Oncologist 2008

The Oncologist 2007

Jurcut et al. J Am Soc Echocardiogr 2008

Author Journal Year

Hare et al. Am Heart J 2009

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Tsai et al. Am J Cardiol 2011

Ho et al. Heart 2010

Cheung et al. Heart 2010

Karabay et al. Cardiology 2010

Am J Cardiol 2011Sawaya et al.


THE ROCKING

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Speckle-tracking echo may help recognizing transmural scar segments at a regional level

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Carasso et al, J Am Soc Echocardiogr 2009;22:242-250.

PRE CRT CRT

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THE TWISTING

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Normal Systolic Heart failure

Rotation &

Twisting

LV apex

LV base

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Normal Heart failure

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Sade LE et al, AJC 2008; 101:1163-1169

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Azienda OspedalieraUniversitaria - Ferrara Trieste 2010Napoli 2010Napoli 2011


Speckle Tracking and Diastolic CHF (Wang J et al, Eur Heart J 2008;29:1283-1289)

Controls Systolic CHF Preserved EF CHF

Str

ain

Lon

git

ud

.

(%

)

Str

ain

Cir

con

f.

(%)

Tw

ist

VS

(gra

di)

Str

ain

rad

iale

(%)

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n

Normal Systolic HF

Diastolic HF C.pericarditis

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Azienda OspedalieraUniversitaria - Ferrara Trieste 2010Napoli 2010Napoli 2011


THE (current) FUTURE

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4D Longitudinal Strain

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4D Circumferential Strain

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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.

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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)”.

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DEFORMATION IMAGING

•Meaningful clinical information

•Better than ejection fraction for prognosis

•Helps identifying subclinical dysfunction

•Helps understanding pathophysiology and decision making

•Promising comprehensive 3D evaluation

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I TESTIMONIALS

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Deformation, what else?


Al congresso SIEC:

-15 RELAZIONI

-40 ABSTRACT

sullo speckle tracking

LA SIEC CI CREDE!


GalderisiMartinielloMaureaPalmieriSeverinoecc…

AscioneCasoCitroD’AndreaDi Salvoecc…

GLI AUTORI NAPOLETANI


NAPOLI

CI CREDENapoli 2011


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.

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Eco 3D ed eco speckle tracking possono essere il futuro

dell’ecocardiografia.

Sta a noi fare in modo che questo accada.

Napoli 2011

Azienda Ospedaliera Universitaria - Ferrara Trieste 2010 Confronto Hard: La deformazione miocardica,...

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