critical care echocardiography€¦ · “insufficient agreement with doppler echo assessment to be...

Critical Care EchocardiographyFuture, present and past…

Dr Ghislaine Douflé

MD, Toronto General Hospital

No conflict of interest

What the future is not…

Not now, nor never…

What the future is not…

At least not now…

http://medirob.com/en/tele.php

Boman, J Am Coll Cardiol Img 2014;7:799–803

Evolution of transoesophageal echocardiography (TEE) over the years from a monitoring

modality to procedural adjunct.

Feroze Mahmood, and Stanton Keith Shernan Heart 2016;102:1159-1167

Copyright © BMJ Publishing Group Ltd & British Cardiovascular Society. All rights reserved.

Evolution of transoesophageal echocardiography (TEE) over the years from a monitoring

modality to procedural adjunct.

Feroze Mahmood, and Stanton Keith Shernan Heart 2016;102:1159-1167

Copyright © BMJ Publishing Group Ltd & British Cardiovascular Society. All rights reserved.

30 years later…

What the future may be…

3D…

30 years later…

Hammoudi, Archives of Cardiovascular Disease (2017) 110, 7—13

Hammoudi, Archives of Cardiovascular Disease (2017) 110, 7—13

Orde et al. Critical Care (2018) 22:198

Orde et al. Critical Care (2018) 22:198

Orde et al. Critical Care (2018) 22:198

“insufficient agreement with Doppler echo assessment to be considered

clinically or statistically acceptable”

What the future may be…

Intracardiac and intracatheter echo…

Platts et al. Intensive Care Medicine Experimental 2014, 2:2

Platts et al. Intensive Care Medicine Experimental 2014, 2:2Platts et al. Intensive Care Medicine Experimental 2014, 2:2

RARA

RV RV

Platts et al. Intensive Care Medicine Experimental 2014, 2:2

Platts et al. Intensive Care Medicine Experimental 2014, 2:2

iCATHe may not provide further global assessment of cardiac structure

and function

Cannot be used to check appropriate location, nor once on ECLS

What the future may be…

Strain…

Truth is: it’s already out there…

Strain…

Sanfilippo et al. Critical Care (2018) 22:183

Teske, Cardiovascular Ultrasound 2007, 5:27

Percentage of deformation (change of length) during contraction ( tissue Doppler or speckle tracking)

ε = L – L 0

L0

Longitudinal shortening

Radial thickening

Twist

Sanfilippo et al. Critical Care (2018) 22:183

Aortic Velocity, Sa, VTI were prognostic parameters of weaning

Velocity Vector Integral was not predictive of successful weaning

Aissaoui, J Am Soc Echocardiogr 2012;25:632-40

What the future may be…

Artificial Intelligence…

IEEE Journal of Biomedical and Health Informatics, Vol. 19, No. 1, January 2015

IEEE Journal of Biomedical and Health Informatics, Vol. 19, No. 1, January 2015

wileyonlinelibrary.com/journal/echo Echocardiography.

Wiley Periodicals, Inc. 2018;35:1402–1418

“However, in this lifetime, it is unlikely that machines will be able to

completely replace human experts in echocardiography interpretation.

With further research and development, AI will be able to aid the

physicians in the recognition of pathology or lack thereof. Nonetheless,

clinical acumen will always be of paramount importance.”

Where are we now…?

Certification…

https://www.esicm.org/education/edec-2/

JANUARY 15TH 2019 (ONLY US)

“Nonetheless, clinical acumen will always be of paramount importance”

Sthetos (chest) scopos (examination)

Laennec 1816

Ghislaine.doufle@mail.utoronto.ca

Merci de votre attention