Erwan DONAL Cardiologie et CIC-IT 804, LTSI INSERM U 647

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1 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

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3 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

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

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

10 L’étude des déformations

11 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

12 2D Speckle Tracking Tracking image after image

13 3D Speckle Tracking The speckle motion is not 2D but 3D

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

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17 3D Speckle Tracking 3D Longitudinal strain

18 3D Speckle Tracking 3D Radial strain

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20 3D Speckle Tracking 3D Circumferential strain

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

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

23 Rotation Velocity of Rotation
base apex

24 3D Speckle Tracking 3D rotation strain Counter clockwise Rotation

25 3D Speckle Tracking Area change

26 3D Speckle Tracking Area strain calculation

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28 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

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

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

31 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

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34 2D Speckle Tracking automatic detection of LV borders

35 2D Deformation

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37 3D-Vectors (displacement)

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40 3D displacement Many post-treatments easy to apply

41 Area Change

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