strain imaging in children: from tissue doppler to 3 d ... 6 m friedberg... · strain imaging in...
TRANSCRIPT
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Strain imaging in children: from Tissue Doppler to 3‐D
M k K F i dbMark K. Friedberg
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Outline• Deformation in the fetus and neonate
• Deformation in pediatric cardiomyopathy p y p y(briefly!)
• Deformation in Congenital heart disease:Deformation in Congenital heart disease:– Tetralogy of Fallot
Hypoplastic left heart syndrome– Hypoplastic left heart syndrome
– ccTGA
3 D t i• 3‐D strain
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M‐ModeStrain imaging in children: From M‐mode to 3D?From M mode to 3D?
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Normal strain values in pediatrics
Weideman, JASE 2002;15:20
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Normal strain values in pediatrics
Lorch , JASE 2008 ; 21:1207
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Lorch , JASE 2008 ; 21:1207
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Lorch , JASE 2008 ; 21:1207
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2D speckle tracking in the fetus
Ta‐Shma A. J Am Soc Echocardiogr. 2008 21:146‐50.
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Velocity Vector Imaging in the Fetus
Younoszai , JASE 2008 21:470.
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Evolution in neonatal life
Pena, JASE 2010;23:294
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Children with cardiomyopathy
• Show AFIShow AFI
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Children with cardiomyopathy
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Radial strain to investigate dyssynchrony and function in DCMRadial strain to investigate dyssynchrony and function in DCM
Controls Dilated Cardiomyopath
y
p
A t i S t 41 9 ± 16 4 14 ± 13 0 0001Anterior Septum 41.9 ± 16.4 14 ± 13 <0.0001
Anterior Wall 47.8 ± 15.6 14.5 ± 12 <0.0001Lateral Wall 52.8 ± 15.8 17 ± 10 <0.0001
Posterior Wall 55 ± 13.2 22 ± 10 <0.0001
Inferior Wall 53.6 ± 13.8 24 ± 13.6 <0.0001Inferior Septum 46 ± 15.4 18.7 ± 12.8 <0.0001
150
200
ex (m
sec)
52
54
56Posterior Wall
Lateral WallInferior Wall
Stra
in (%
)
22
24
Posterior Wall
Inferior Wall
Stra
in (%
)
50
100
adia
l Dys
sync
hron
y In
de
44
46
48
50
Inferior Septum
Anterior wall
r=0.98erag
e Pe
ak R
adia
l S
16
18
20
Lateral Wall
Inferior Septum
r=0.760 07er
age
Peak
Rad
ial S
Friedberg AJC, 2008
0p<0.0001
Dilated CardiomyopathyControls
Ra
494 496 498 500 502 504 506 508 510 512 51440
42 Anterior Septum p<0.0001Ave
Average Time to Peak Strain (msec)320 330 340 350 360 370 380 390 400 410
14 Anterior WallAnterior Septum p=0.07
Ave
Average Time to Peak Radial Strain (msec)
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Regional deformation by TDI strain in HCM
Ganame, EHJ, 2007 28, 2886
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Speckle tracking for diagnosis of LVNC?
Eidem, Pediatr Cardiol. 2009 ;30:682‐9.
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Effect of anthracyclines on deformation
Ganame, JASE 2007;20:1351
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9y F, after chemotherapy
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Congenital heart diseaseCongenital heart disease
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Congenital heart disease and fiber orientation
normal
Superficial layers
tricuspid atresia Different fiber orientation
Different 3‐D deformation
Middle layers
normalSanchez‐Quintana, D et al. Heart 1999 ;81:182
tricuspid atresia
Slide courtesy of Luc Mertens
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Small/ absent contra‐lateral ventricle affects ventricular strain and torsion
Fogel , Circulation 1998;98;330
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RV strain
Weideman, JASE 2002;15:20‐8Weideman, JAS 00 ; 5: 0 8
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RV deformation after ASD closure
Eyskens, JASE 2006;19:994
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RV strain in Pulmonary valve Stenosis
Weidemann, Ped Cardiol, 2002;23:292
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Strain and strain rate after TOF repair
Weidemann, Am J Cardiol 2002;90:133–138
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Strain and strain rate after TOF repair
Weidemann Am J Cardiol 2002;90:133–138Weidemann, Am J Cardiol 2002;90:133–138
Tzemos, AJC 2009; 103:420
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RV strain/ SR in TOF
Solarz, J Am Soc Echocardiogr 2004;17:338‐44.
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Strain and SR after PVR in TOF
Knirsch, Pediatr Cardiol; 2008 29:718–725
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Strain and SR after PVR in TOFN=58Echo analysis at median intervals of 2.8 months before and 30 months after PVR.Echo analysis at median intervals of 2.8 months before and 30 months after PVR.
Kutty, JASE 2008;21:1216
Before After Control
Frigiola, Circ. 2004;110[suppl II]:II‐153–II‐157
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RV strain after catheter PVR
Friedberg, Eur J Echo 2009 10: 585
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PVR: Short term changes in deformationn Pre PVR Post PVR p- valuen Pre PVR
(mean ± SD)Post PVR(mean ± SD)
p value
Strain LV % 10 -22.37 ± 8.0 -20.02 ± 11.8 0.22Strain IVS % 10 -7.04 ± 9.1 -14.10 ± 6.4 0.02Strain RV % 10 -14.56 ± 13.9 -23.53 ± 6.3 0.04
Strain Rate LV (s-1) 10 -1.48 ± 0.3 -1.50 ± 0.5 0.47Strain Rate IVS (s-1) 10 -0.29 ± 1.1 -1.06 ± 0.5 0.049
StrainRate RV (s-1) 10 -1.53 ± 1.1 -2.07 ± 0.7 0.13 Septal Strain% Pre-Post PPVI
5 00
10.00
15.00
20.00
Series1Series2
-15.00
-10.00
-5.00
0.00
5.00
pre post
Sep
tal S
train
%
Series3Series4Series5Series6Series7Series8Series9
-30.00
-25.00
-20.00 Series10
Moiduddin, AJC 2009;104:862
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LV function in TOF
Friedberg, Eur J Echo 2009 10, 585
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LV deformation after TOF repair
Weidemann, Am J Cardiol 2002;90:133–138
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TOF C l P lTOF Controls P value
Myocardial Deformation
LV Radial strainbase* 30±14 39±20 <0.01mid* 36±16 50±22 <0.01apex† 38± 19 54±20 <0.01LV Radial strain ratebase* 1.5±0.74 1.9±0.82 <0.01mid* 1 4±0 39 1 9±0 61 <0 01mid* 1.4±0.39 1.9±0.61 <0.01apex† 1.6±0.77 2.0±0.65 0.01LV Circumferential strainbase* -16±6 -18±7 0.1mid* -16±5 -19±6 <0.01apex† -19+/-6 20+/-6 0.4Longitudinal strainRV (base+mid) -23±5 -27±9 0.03LV (base+mid) -16±5 -17±4 0.4
Fernandes, AEPC, 2010
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LV dyssynchrony in TOF
Abdul Khaliq, JACC 2005;45:915
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Hypoplastic Left Heart SyndromeHypoplastic Left Heart Syndrome
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Assessment of function in single ventricles
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HLHS good RV Deformation
Insert cpa strain curves
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RV‐PA conduit vs BTS in Stage 1 Norwood
Hughes, Heart 2004;90:191–194
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Dyssynchrony in HLHS using VVI
Friedberg, JASE 2007;20:1073‐1079
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Congenitally corrected transposition of the great arteries
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Clinical deterioration in ccTGA is linked to RV failure
Roos‐Hesselink, EHJ 2004; 25, 1264
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Strain and SR after Senning in ccTGA
LV posterior wall radial function
Eyskens, Cardiol Young 2004; 14: 255–264
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Asymptomatic patients with ccTGA
Bos, JASE 2006;19:1033
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RV adaptation after atrial switch
Pettersen, JACC, 2007;49:2450
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Impaired Diastolic Reserve in ccTGA
S i V i l P l V i lSystemic Ventricle Pulmonary Ventricle
Poerner J Am Soc Echocardiogr 2007;20:1 285
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Serial Evaluation of LV function after ALCAPA repair
Mertens, Cardiol Young, 2001
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Child with ALCAPA
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3D strain3D strain
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Left Ventricular Deformation is 3‐dimensional
Courtesy of Ben Eidem, MD
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We evaluate strain in 3We evaluate strain in 3‐‐dimensionsdimensions
Longitudinal strain
Radial strain
Circumferential strain
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Abstracts at the upcoming AHA
• “Is Left Ventricular Twisting Obtained Using Three‐Is Left Ventricular Twisting Obtained Using Threedimensional Ultrasound Speckle Tracking Imaging Useful in Assessing Left Ventricular Function?‐Comparison with Invasive Parameters”
• “Left Ventricular Eccentricity Impairs Three‐Dimensional Systolic Radial Strain and Torsion in
f f l f ll hPatients After Repair of Tetralogy of Fallot: A Three‐Dimensional Speckle Tracking Analysis”
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3‐D strain
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3‐D strain
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3‐D rotation and torsion
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17 year old with AS and AI
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9 yr, girl, pulmonary stenosis
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Problems using strain in clinical practice• Technical acquisition• Technical acquisition• Normal values vary between techniques and studies• Large inter/ intra observer variabilityLarge inter/ intra observer variability• Large scatter/ variation compared to reference methods• Conflicting data regarding load‐dependencyConflicting data regarding load dependency• Regional vs global function‐what and where should we be measuring
• Which method should we be using S/ SR?• Standardization (eg peak vs mean velocities (colour vs pulsed Doppler)
• Long post‐acquisition processing timeI i f l i li i l d i i ki• Incorporation of results into clinical decision making
• Data overload but small numbers
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