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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

  1. Echossential or Echorrhoea? Idle thoughts on some more advanced echocardiographic techniques Dave Dickson BVetMed DVC MRCVS RCVS Specialist in Cardiology

  3. DICKSON WHAT I TALK ABOUT WHEN I TALK ABOUT ECHO

  4. Atrial thrombus Athletic heart Echo courtesy of Liva Vatne Mitral stenosis Pulmonary hypertension

  5. Can I be getting more from my echo?

  6. Left ventricular systolic function Bourguingnon, Dickson, Vatne, Harris, Caivano & Rishniw JVC In Press

  7. 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

  8. Tissue Doppler Imaging = = =

  9. Tissue Doppler Imaging s’ Ejection Filling e’ a’ IVCT IVRT

  10. Tissue Doppler Imaging e’ e’ a’ e’ e’ e’ a’

  11. Tissue Doppler Imaging

  12. Tissue Doppler Imaging

  13. Tissue Doppler Imaging in DMVD and DCM

  14. Tissue Doppler Imaging s’ e’ a’

  15. Speckle Tracking Echocardiography t 0 t 1 = -15%

  16. Speckle Tracking Echocardiography

  17. Speckle Tracking Echocardiography s’ e’ a’

  18. Measuring STE

  19. Speckle Tracking Echocardiography GLSRs GLSRe GLSRa GLS

  20. Speckle Tracking Echocardiography

  21. Speckle Tracking Echocardiography

  22. Speckle Tracking Echocardiography ?

  23. Right Ventricular Function

  24. Right Ventricular Function

  25. Tricuspid Annular Plane Systolic Excursion TAPSE:Ao >0.65 = CRAPSE =

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

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

  28. Speckle of the RV

  29. Thoughts on all this fancy echo stuff

  30. Wake up, it’s Quiz time!

  32. Diastolic Function and Filling Pressures Isovolumic relaxation Rapid filling

  33. Diastolic Function and Filling Pressures E A E A

  34. Mitral inflow in CHF MV E vel >1.2-1.4m/s Borgarelli JVIM 2008, Nakamura JVIM 2014, Sargent JVC 2015)

  35. Mitral inflow velocity MV E ∝ LAP (LVFP) MV E ∝ LVFP x LV relaxation (incl age & HR) IVRT ∝ 1/ LV relaxation (incl age & HR) MV E ∝ LVFP x LV relaxation E/IVRT ∝ LVFP IVRT LV relaxation

  36. E/IVRT =

  37. Tissue Doppler Imaging and diastolic function MV E ∝ MV E ∝ LVFP x LV relaxation 1 x LVFP x LV relaxation TDI e’ LV relaxation TDI e’ ∝ 1/LV relaxation E/e’ ∝ LVFP

  38. Doppler estimates of filling pressure

  39. Doppler estimates of filling pressure E/IVRT >2.5 >1.9 Mitral valve disease DCM

  40. Case Example “Iolo” E/IVRT 1.5 LVDDN 2.1 LA:Ao 1.95

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

  42. Case Example Dec 2019 July 2020 July 2020

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

  44. Thoughts on all this fancy echo stuff

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