ventricular assessment of size,shape and function

8/6/2019 Ventricular Assessment of Size,Shape and Function

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Element 52.00Element 52.00

PellerinPellerin


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The 20th Echo in Context Video Teleconference

The pulse and the beat. ECG and Echo

Saturday, 26th February 2005

The 20th Echo in Context Video Teleconference

The pulse and the beat. ECG and Echo

Saturday, 26th February 2005

Ventricular Assessment ofSize, Shape, and Function in

ECH Disorders

Ventricular Assessment ofSize, Shape, and Function in

ECH Disorders

Dr. Denis Pellerin MD, PhDDr. Denis Pellerin MD, PhD


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g Ventricular assessment of size, shape, and function has

important

prognosis and therapeutic implications

g Ventricular volume predicts mortality better than ejection

fraction

Simpsons rule in 2D (biplane), in 3D (LVESD)

Ventricular mass

g Ventricular geometry is a surrogate for myocardial fibers

orientation

Adaptive mechanism to maximize pump efficiency(remodeling)

Changes in radial, longitudinal and circumferential motion

Ratio of WT to cavity dimension, Sphericity index

g Ventricular assessment of size, shape, and function has

important

prognosis and therapeutic implications

g Ventricular volume predicts mortality better than ejection

fraction

Simpsons rule in 2D (biplane), in 3D (LVESD)

Ventricular mass

g Ventricular geometry is a surrogate for myocardial fibers

orientation

Adaptive mechanism to maximize pump efficiency(remodeling)

Changes in radial, longitudinal and circumferential motion

Ratio of WT to cavity dimension, Sphericity index


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Aurigemma GP et al 2002Aurigemma GP et al 2002

NormalNormal

Concentric

Remodeling

(Hypertension)

Concentric

Remodeling

(Hypertension)

Concentric

Hypertrophy

(Hypertension/

Aortic)

Concentric

Hypertrophy

(Hypertension/

Aortic)Hypertrophic

Cardiomyopathy

Hypertrophic

Cardiomyopathy

Eccentric

Hypertrophy

(Aortic/

Mitral

Regurgitation)

Eccentric

Hypertrophy

(Aortic/

Mitral

Regurgitation)Dilated

Cardiomyopathy

Dilated

Cardiomyopathy


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Assessment of Global LV Systolic FunctionAssessment of Global LV Systolic Function

RWMA, post op, LBBBRWMA, post op, LBBB

NoNo YesYes

M-mode measurementsTeicholz methodM-mode measurementsTeicholz methodg

Visual estimation of LVEFg Biplane Simpsons method

g Mitral annular velocity

g RWMSI

g dP/dt

g

Visual estimation of LVEFg Biplane Simpsons method

g Mitral annular velocity

g RWMSI

g dP/dt


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LV Volumes and Systolic FunctionLV Volumes and Systolic FunctionVENTRICULAR VOLUMESVENTRICULAR VOLUMES

g

Intra observer variability: 4 a 6%

g Inter observer variability:

g

Intra observer variability: 4 a 6%

g Inter observer variability:

8.5% EDV8.5% EDV 16.5% ESV16.5% ESV

g A variation ofg A variation of 15% for EDV

25% for ESV

10& for LVEF

15% for EDV

25% for ESV

10& for LVEF

is required before concluding on a

significant change.

is required before concluding on a

significant change.


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Mitral Annular VelocityMitral Annular Velocity

Gulati VK et al. Am J Cardiol 1996; 77:979-984Gulati VK et al. Am J Cardiol 1996; 77:979-984

g Velocity assessment is not dependent on endocardial definition

Conventional echo 77%, DTI measurements 100% (Alam JASE 2000)

g MAV > 5.4 cm/s was 88% sensitive and 97% specific for LVEF > 50%

g Limitations: prosthetic MV or annulus, mitral annular calcifications

g Velocity assessment is not dependent on endocardial definition

Conventional echo 77%, DTI measurements 100% (Alam JASE 2000)g MAV > 5.4 cm/s was 88% sensitive and 97% specific for LVEF > 50%

g Limitations: prosthetic MV or annulus, mitral annular calcifications


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Atrial FibrillationAtrial Fibrillation

Perrenoud JJ 1989Perrenoud JJ 1989


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Assessment of Regional LV SystolicFunction

Assessment of Regional LV SystolicFunction

g SEMI QUANTITATIVE ANALYSISConventional 2D echo

LV cavity contrast opacification in 2D

g QUANTITATIVE ANALYSIS

Myocardial velocity and deformation Imaging

Color kinesis + LVO

3D echo (+ LVO)

g At rest and during stress

g SEMI QUANTITATIVE ANALYSISConventional 2D echo

LV cavity contrast opacification in 2D

g QUANTITATIVE ANALYSIS

Myocardial velocity and deformation Imaging

Color kinesis + LVO

3D echo (+ LVO)

g At rest and during stress


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Cineloop of a patient with CHF and narrow QRS

complexes

Cineloop of a patient with CHF and narrow QRS

complexes

Cineloop of a patient with CHF and LBBBCineloop of a patient with CHF and LBBB


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??

Delay between RV and LV activation 85 msDelay between RV and LV activation 85 ms

Grines CL et al. Circulation 1989Grines CL et al. Circulation 1989


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CONCLUSIONCONCLUSIONg Ventricular assessment of size, shape and

function has important prognosis andtherapeutic implications

g Global and regional LV function: select your

parameter (when poor endocardial definition or

abnormal septal Motion)

g RWM analysis requires training

g Conventional analysis/Quantitative analysis

g Ventricular assessment of size, shape and

function has important prognosis andtherapeutic implications

g Global and regional LV function: select your

parameter (when poor endocardial definition or

abnormal septal Motion)

g RWM analysis requires training

g Conventional analysis/Quantitative analysis


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ventricular assessment of size,shape and function

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