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: contractility from the base to the apex Radial function: contractility from the outer to the center of the LV cavity Circonferential &Torsion

What are the Speckle providing? LV Frame 1 Frame 2 leaflet

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

L’étude des déformations

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

2D Speckle Tracking Tracking image after image

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

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

3D Speckle Tracking 3D Longitudinal strain

3D Speckle Tracking 3D Radial strain

3D Speckle Tracking 3D Circumferential strain

Assessment of Torsion / Rotation Parasternal short axis view at the level of the mitral leaflets at the apex

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

Rotation Velocity of Rotation base apex

3D Speckle Tracking 3D rotation strain Counter clockwise Rotation

3D Speckle Tracking Area change

3D Speckle Tracking Area strain calculation

Multiparametric Algorithm Atrio-ventricular Dyssynchrony Inter-ventricular Dyssynchrony Intra-ventricular Dyssynchrony Radial = L+SAX 2D, Visual assessment 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

Clinical application VD pace only CRT on Global area strain -13,8%

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

Conclusion We are at the Beginning ►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. We are at the Beginning

2D Speckle Tracking automatic detection of LV borders

2D Deformation

3D-Vectors (displacement)

3D displacement Many post-treatments easy to apply

Area Change