Dispersão mecânica dispensa a ressonância

PowerPoint Presentation

https://www.sciencedirect.com/science/article/pii/S0894731717303504?via%3Dihub

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Highlights

Strain echocardiography can detect altered myocardial mechanics in patients with AS.

Pronounced mechanical dispersion is associated with worse prognosis in patients with AS.

Mechanical dispersion adds incremental prognostic value to LVEF, atrioventricular impedance, and global longitudinal strain.

Mechanical dispersion predicts mortality independently of LVEF and AVR surgery status.

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Recente descoberta do Strain, a dispersão mecânica responde perguntas anteriormente dedicadas a RM.

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Muito mais fácil e barata de realizar, a avaliação da dispersão mecânica pode virar essencial.

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Slide 1

VVI (Vetores) é melhor?

nihms-374575-f0001

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Velocity vector imaging (VVI)

The new off-line software (syngo Velocity Vector Imaging technology [VVI], Siemens) provides angle-independent 2D velocity, strain, and SR. “Feature tracking” of the myocardium with VVI is achieved through the combination of speckle tracking, mitral annulus motion, tissue-blood border detection, and the periodicity of the cardiac cycle using R-R intervals. In order to improve the tracking results, the algorithm applies a carefully designed sequence of intermediate passages to accurately follow myocardial motion. All these passages are performed with the aid of Fourier techniques that ensure a higher accuracy using the periodicity of the heart motion. From the multiple 1-dimensional interrogations, a 2D solution is achieved and the displacement information of the tracked points is obtained. The endocardial border is visually identified by the user and manually outlined. The manual placement of an endocardial tracing over 1 frame is then automatically tracked throughout the cardiac cycle. The software allows editing of the initial trace if the resulting tracking is assessed as suboptimal. The endocardial velocity is derived as the ratio between frame-to-frame displacement and the time interval. The velocity vectors in the 2D plane are displayed throughout the cardiac cycle, representing both the magnitude of the velocity and the direction of the motion (Fig. 1). Strain and SR are obtained by comparing displacement of the speckles in relation to each other along the endocardial contour throughout the cardiac cycle.

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3348770/

http://www.onlinejase.com/article/S0894-7317(12)00051-X/pdf

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Ainda estamos longe de definir uma tecnologia única para a fisiologia cardíaca.

Mais ainda de entender completamente o funcionamento cardíaco.

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Acabou o Twist?

 

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http://circimaging.ahajournals.org/content/2/2/123.long

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Apical Rotation Assessed by Speckle-Tracking Echocardiography as an Index of Global Left Ventricular Contractility

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Conclusions— Apical rotation assessed by STE is an effective noninvasive index of global LV contractility and is more closely related to dP/dtmax than LV EF.

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Da mesma forma que o US intra-coronário revolucionou o conhecimento da Aterosclerose, a ponto de não ser absorvido integralmente por médicos clássicos, a Deformação miocárdica faz a mesma revolução com a ecocardiografia.

A maioria não entende os achados.

A rotação está relacionada ao perfeito mecanismo da Diástole.

Que só está preservado 100%, no miocárdio sadio.

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Comparar com outras medidas, que são de Doppler, volumétricas ou mesmo longitudinais, revela a fase atual de conhecimento mínimo do processo.

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Strain da aorta. Estenose e insuficiência

echo13236-fig-0001

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Aortic Valve Disease and Vascular Mechanics: Two-Dimensional Speckle Tracking Echocardiographic Analysis

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http://onlinelibrary.wiley.com/doi/10.1111/echo.13236/full

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Conclusions

Quantitative measures of aortic mechanics were lower for AS patients, suggesting a more significant derangement of aortic elastic properties. In the context of AVD, vascular mechanics assessment proved useful in gauging clinical prognosis.

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Estudo interessante mostra o efeito da insuficiência e da estenose na Aorta.

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A marcante redução da distensão da Aorta na estenose pode ser vista claramente com o Strain.

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Mais uma demonstração da utilidade do método.

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