novel echocardiographic modalities: 3d echo, speckle
TRANSCRIPT
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Stefano Caselli, MD, PhD
Ospedale San Pietro Fatebenefratelli
Rome, Italy
Novel echocardiographic modalities: 3D echo,
speckle tracking and strain rate imaging.
Potential roles in sports cardiology.
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Athlete’s HeartDCM
HCM
Other forms of LVH
Differential diagnosis of the athlete’s heart
Up to 15% of athletes may develop left ventricular enlargement
which rises the differential diagnosis with DCM
Up to 2% of athletes show LV wall thickening which rises the
differential diagnosis with HCM
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Beyond ECG and conventional Echo
Pelliccia et al NEJM 2008
Abnormal ECG
Normal ECG
McLeod et al JACC 2009
Abnormal
EKG, 94%
Normal
EKG, 6%
HCM patients
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The need for new diagnostic tools!
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Relative distance
Speckle Tracking Echocardiography
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Strain is a measure of deformation.
Strain rate is the velocity of deformation
Strain(%), ε =(L0 – L1)
L0
Strain rate = ε / sec
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Components of myocardial strain
S. Caselli, MD
Longitudinal strain: shortening (-)
Transverse strain: thickening (+)
Circumferential strain: shortening (-)
Radial strain: thickening (+)
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Longitudinal Strain
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Longitudinal Strain Rate
Peak S
Peak E Peak A
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Myocardial Strain in Athletes
Nottin S et al J Physiol 2008
Longitudinal Strain
(Negative)
Controls
Athletes
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Nottin S et al. Circ Cardiovasc Imaging 2009
Effects of EXTREME EXERCISE on
LV strain in athletes
Lo
ng
itu
din
al S
tra
in (
%)
23 triathlon athletes
participating the Ironman
competition.
STE was performed
before and soon after the
race.
All components of strain
were reduced in systole,
after the race.
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Galderisi et al. J Am Soc Echocardiogr 2010
Controls Rowers Hypertension
Longitudinal -21 ± 2 -22 ± 3 -17 ± 3*
Circumferential -18 ± 3 -18 ± 2 -16 ± 4*
Radial 46 ± 16 48 ± 19 46 ± 17
Left Ventricular Strain in pathologic left
ventricular hypertrophy (LVH)
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30 Hypertensive pts,
30 Power athletes
48 controlsHypertensive pts had:
Global longitudinal strain
Peak systolic strain rate
Early diastolic strain rate
Saghir M et al J Am Soc Echocardiogr 2007
Left Ventricular Strain in pathologic left
ventricular hypertrophy (LVH)
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Hypertrophic Cardiomyopathy
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Strain imaging in HCM
0
5
10
15
20
25
30
35
40
Transverse Radial
Serri et al. J Am Coll Cardiol 2006
Controls HCM
Longitudinal Circumferential Transverse Radial
p<0.001 p<0.001 p<0.001 p<0.001
0
2
4
6
8
10
12
14
16
18
20
Transverse Radial
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29 Soccer players, 26 nHCM and 17 controls
Circumferential, transverse and radial strain significantly
reduced in HCM patients compared to athletes and controls.
Longitudinal strain reduced in hypertrophied segments.
Richand V, Am J Cardiol 2007
Strain imaging in HCM
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Abozguia K et al. Am Heart J 2010
Strain rate in HCM
56 nHCM patients
All strain components
reduced compared to
controls.
All underwent
cardiopulmonary
exercise test.
Peak VO2 was reduced
in nHCM patients.
Longitudinal strain rate
correlated significantly
with peak VO2
Reduced Strain Rate predicts reduced
exercise capacity in nHCM patients.
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Live 3D Echocardiography
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Volumes & EF
LV Shape
LV Mass
LV regional function /
synchronicity
Quantitative Analysis
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3D echo in athletes.
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3D echo in athletes.
Upper limits for LV end-diastolic volume and mass
Caselli S et al. Am J Cardiol 2011 (in press)
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3D echo in athletes.
LV Mass EDV ESV
Controls Skill Strength Combined Endurance
Caselli S et al. Am J Cardiol 2011 (in press)
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LV Mass
End diastolic Volume=
Left Ventricular Remodelling Index
LVRI
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Hypertrophic
Cardiomyopathy
Dilated
Cardiomyopathy
Competitive
Athletes
Healthy
Volunteers
De Castro S Caselli S - Heart 2007
End-Diastolic Volume
LV
Ma
ss
LVRI = 2.0
LVRI = 0.5
LV
Ma
ss
Left Ventricular Remodelling Index
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Left Ventricular Remodelling Index
End-Diastolic Volume
Caselli S et al. Am J Cardiol 2011 (in press)
Patterns of LV
adaptations are similar
in all athletes,
regardless to the
specific sport discipline
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Apical
Medium
Basal
SeptumAnterior
Lateral
Inferior
Myocardial Dispersion Index
68 subjects including controls,
athletes, hypertensive and
HCM.
LV was divided in a 12
segments model.
MDI was calculated as the
mean Standard Deviation at
the basal medium and apical
segments.
Caselli S et al. Am J Cardiol 2008
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MDI > 1.13
Sensitivity 93%
Specificity 100%
Caselli S et al. Am J Cardiol 2008
Myocardial Dispersion Index
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Left Ventricular Non Compaction
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Left Ventricular Non Compaction
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Left Ventricular Non Compaction
17 patients with LVNC.
Analysis of Trabecular
Volume by 3D
echocardiography.
No differences between
Athletes and controls
LVNC patients had a
4-fold increase in
Trabecular Volume.
Caselli S et al. Euroecho 2010
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Beyond EKG
In the majority of cases the screening of the athletes with
EKG and conventional echocardiography allows the
correct definition of athlete’s heart and differential
diagnosis with cardiomyopathies.
There is however a smaller percentage of young athletes
who fall in the so called “grey zone”.
Speckle tracking echocardiography allows a deeper and
accurate investigation of myocardial mechanics in systole
and diastole.
3-dimensional echo allows a better description of the
anatomy and geometry of the heart chambers.
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Thank you
Stefano Caselli