Echossential or Echorrhoea? Idle thoughts on some more advanced - - PowerPoint PPT Presentation

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Echossential or Echorrhoea? Idle thoughts on some more advanced - - PowerPoint PPT Presentation

Nov 28, 2022 409 likes •873 views

Echossential or Echorrhoea? Idle thoughts on some more advanced echocardiographic techniques Dave Dickson BVetMed DVC MRCVS RCVS Specialist in Cardiology DICKSON WHAT I TALK ABOUT WHEN I TALK ABOUT ECHO Atrial thrombus Athletic heart Echo

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Echossential or Echorrhoea?

Idle thoughts on some more advanced echocardiographic techniques

Dave Dickson

BVetMed DVC MRCVS RCVS Specialist in Cardiology

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DICKSON

WHAT I TALK ABOUT WHEN I TALK ABOUT ECHO

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Echo courtesy of Liva Vatne

Atrial thrombus Athletic heart Mitral stenosis Pulmonary hypertension

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Can I be getting more from my echo?

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Left ventricular systolic function

Bourguingnon, Dickson, Vatne, Harris, Caivano & Rishniw JVC In Press

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Left ventricular systolic function

SMOD superior to MM at detecting early DCM Sphericity index doesn’t improve upon MM EPSS is sens and spec and comparable to SMOD

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= = =

Tissue Doppler Imaging

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Tissue Doppler Imaging

s’ e’ a’ IVCT Ejection IVRT Filling

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Tissue Doppler Imaging

e’ e’ e’ a’ a’ e’ e’

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Tissue Doppler Imaging

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Tissue Doppler Imaging

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Tissue Doppler Imaging in DMVD and DCM

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Tissue Doppler Imaging

s’ e’ a’

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Speckle Tracking Echocardiography

t0 t1 = -15%

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Speckle Tracking Echocardiography

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Speckle Tracking Echocardiography

s’ e’ a’

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Measuring STE

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Speckle Tracking Echocardiography

GLS GLSRs GLSRe GLSRa

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Speckle Tracking Echocardiography

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Speckle Tracking Echocardiography

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Speckle Tracking Echocardiography

?

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Right Ventricular Function

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Right Ventricular Function

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Tricuspid Annular Plane Systolic Excursion

= =

CRAPSE

TAPSE:Ao >0.65

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TAPSE

iTAPSE <3.3mm/kg^0.3 TAPSE:Ao <0.65 nTAPSE<3.2mm/kg^0.3

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TDI S’

Visser 2015 S’ min > 4.26 cm/s/kg S’N = 4.262 x BW^0.233

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Speckle of the RV

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Thoughts on all this fancy echo stuff

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Wake up, it’s Quiz time!

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Diastolic Function and Filling Pressures

Isovolumic relaxation Rapid filling

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Diastolic Function and Filling Pressures

E A E A

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Mitral inflow in CHF

MV E vel >1.2-1.4m/s Borgarelli JVIM 2008, Nakamura JVIM 2014, Sargent JVC 2015)

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Mitral inflow velocity

MV E ∝LVFP x LV relaxation (incl age & HR) MV E ∝LAP (LVFP) IVRT ∝ 1/ LV relaxation (incl age & HR) MV E ∝ LVFP x LV relaxation IVRT LV relaxation

E/IVRT ∝ LVFP

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E/IVRT

=

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Tissue Doppler Imaging and diastolic function

MV E ∝LVFP x LV relaxation TDI e’ ∝1/LV relaxation MV E ∝ 1 x LVFP x LV relaxation TDI e’ LV relaxation

E/e’ ∝ LVFP

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Doppler estimates of filling pressure

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DCM

Doppler estimates of filling pressure

Mitral valve disease

E/IVRT >2.5 >1.9

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Case Example

E/IVRT 1.5 “Iolo” LVDDN 2.1 LA:Ao 1.95

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Case Example

Dec 2019 LVDDN = 2 LA:Ao =1.85 MV E = 1m/s IVRT = 78ms E/IVRT = 1.34

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Case Example

Dec 2019 July 2020 July 2020

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Case Example

July 2020 LVDDN 2 LA:Ao 2.1 July 2020 MV E = 1.4m/s IVRT = 48ms E/IVRT = 2.92 Dec 2019 LVDDN = 2 LA:Ao =1.85 MV E = 1m/s IVRT = 78ms E/IVRT = 1.34

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Thoughts on all this fancy echo stuff

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