Vers une nouvelle dfinition de lischmie myocardique Genevive - - PowerPoint PPT Presentation

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vers une nouvelle d finition de l isch mie myocardique
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Vers une nouvelle dfinition de lischmie myocardique Genevive - - PowerPoint PPT Presentation

Feb 22, 2023 116 likes •324 views

Vers une nouvelle dfinition de lischmie myocardique Genevive Derumeaux Hpital Louis Pradel, Lyon, France Dclaration de Relations Professionnelles - Disclosure Statement of Financial Interest J'ai actuellement, ou j'ai eu au cours

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SLIDE 1

Vers une nouvelle définition de l’ischémie myocardique

Geneviève Derumeaux

Hôpital Louis Pradel, Lyon, France

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SLIDE 2

Déclaration de Relations Professionnelles - Disclosure Statement of Financial Interest

  • Grant/Research Support
  • Consulting Fees/Honoraria
  • AstraZeneca
  • Toshiba, Servier

I currently have, or have had over the last two years, an affiliation or financial interests or interests of any order with a company or I receive compensation or fees or research grants with a commercial company :

Affiliation/Financial Relationship Company

J'ai actuellement, ou j'ai eu au cours des deux dernières années, une affiliation ou des intérêts financiers ou intérêts de tout ordre avec une société commerciale ou je reçois une rémunération ou des redevances ou des octrois de recherche d'une société commerciale :

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SLIDE 3
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SLIDE 4

Ischemic free cells (red) vs. normal free cells (blue)

 no delay in onset of contraction  delay in Time to Peak (TTP) and prolonged Relaxation Half Time (RT50)  reduced peak contraction

200 400 600 800 1000 1200 1400 1600 1800 2000 2200

  • 0.06
  • 0.04
  • 0.02

TTP RT

50

TTP RT

50

Time (ms) cell contraction

200 400 600 800 1000 1200 1400 1600 1800 2000 2200

  • 0.06
  • 0.04
  • 0.02

TTP RT

50

TTP RT

50

Time (ms) cell contraction

Characteristics of ischaemia

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SLIDE 5

Characteristics of ischaemia

Theroux et al. Circ Res 1974 Circumferential segment length

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SLIDE 6
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SLIDE 7

« Whether an ischemic myocardial segment is hypokinetic or dyskinetic depends on the balance between the stress imposed on that segment and the sum of the active and passive stresses within the segment »

Post-systolic shortening

Skulstad et al, Circulation 2002 « Active contraction was defined as elevated LV pressure and stress during post-systolic shortening»

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SLIDE 8

Contractile Force Loading Conditions Interaction with Adjacent Segments

Characteristics of ischaemia

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SLIDE 9

Lucats I et al; EHJ 2004

Characteristics of ischaemia

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SLIDE 10

B Bijns et al; EJE (2010)

Several of the methods for global assessment concentrate

  • nly on radial function, ignoring longitudinal function,

which in most cardiac pathology is altered before changes

  • ccur in radial indices.

Rationale of deformation evaluation

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SLIDE 11

Myocardial function and ischemia

Réant P et al; JACC 2008

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SLIDE 12

Impact of ischemia on LV function

Radial Function Longitudinal and Circonferential Function

Réant P; J. Am. Coll. Cardiol. 2008;51;149-157

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SLIDE 13

Seo Y; Circ Cardiovasc Imaging 2009

Validation of 4D speckle Tracking Imaging to quantify Regional Myocardial Deformation

Parametric images of regional strain after MI

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SLIDE 14

Gibbons et al. JACC 2004 Ørn S, AJC 2007

The final infarct size following is predicted by: (i) the duration of ischaemia, (ii) the size of the area at risk, and (iii) the amount of collateral circulation

Infarct size is the major determinant of prognosis after myocardial infarction

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SLIDE 15

Liebermann , Circulation 1981

Impact of MI on LV function

  • 13%
  • 13%

Segmental strain differs with the level of transmural extension of MI

Gjesdal O. Clin Sci 2007

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SLIDE 16

4D-strain and assessment of MI extend

Hayat D; Am J Cardiol 2011

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SLIDE 17

Evidence for prognostic value of strain in ICM

  • Park YH, et al.

« Prognostic value of longitudinal strain after primary reperfusion therapy in patients with anterior-wall acute myocardial infarction» J Am Soc Echocardiogr 2008

  • Stanton T et al.

« Prediction of All-Cause Mortality From Global Longitudinal Speckle Strain: Comparison With Ejection Fraction and Wall Motion Scoring” Circ Cardiovasc Imaging 2009

  • Antoni Ml et al.

« Prognostic importance of strain and strain rate after acute myocardial infarction” Eur Heart J 2010

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SLIDE 18

Prediction of recovery of LV function at 1-year follow-up.

Pronostic value of global longitudinal strain after reperfused MI

  • 156 patients
  • Acute MI => primary PTCA
  • 1st echo. 48h after MI; 2d echo at 1 year

Mollema S; Circ Cardiovasc Imaging. 2010;3 Antoni M; European Heart J 2010;31

All cause mortality Combined endpoints Reinfarction, revascularisation, Heart failure

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SLIDE 19

BASELINE 30 DAYS BASELINE 30 DAYS Altman M, Euroecho 2012

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SLIDE 20

Conclusion

Rest DSE

max. SRsys

sys PSI

max. SRsys

sys PSI Normal

5 s-1 60 %

2 %

Stunned Acute Ischemia Nontransmural MI Transmural MI

Higher compared to normal Lower compared to normal Decrease Increase No response Biphasic response