Fall 3 Ekokardiografi

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2 Fall 3 Ekokardiografi

3 Fall 3 1. Vilken etiologi har vi till patientens insufficiens? 2. Tillför 3D undersökningen något ytterligare? 3

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16 När är 3D/4D eko bättre än 2D? Strong evidence for use today: LV Function, Volumes Valvular disease Mitral valve MS MR Can give additional information: RV function, volumes IC Shunts LV regional function LV mass Stressecho, Contrast Dyssynchrony Valvular disease AS,AR,TR,TS.(PI,PS)

17 Mitralisinsuff Surgeons view :

18 Mitralisinsuff

19 Var är prolapsen lokaliserad? 1. P1 2. P2 3. P2 4. A1 5. A2 6. A3 7. P2-mediala commissuren 8. P2-laterala commissuren

20 3D TEE surgeons view

21 Var är prolapsen lokaliserad? 1. P1 2. P2 3. P2 4. A1 5. A2 6. A3 7. P2-mediala commissuren 8. P2-laterala commissuren

22 Increasing complexity increasingly important to do preop 3DTEE

23 4D Auto LVQ snabbare än BP Simpson 47 (+4,4) s 59 (+8,3) s p<0,0001 Shahgaldi et al Echocardiography 2010

24 Is the superiority of left ventricular ejection fraction measurement by real-time three-dimensional echocardiography over two-dimensional echocardiography dependent in image quality? Skott V 1, Shahgaldi K 2,3, Siira L 4, Boskov V 4, Bäck M 5, Winter R 2,3 1 Department of Clinical Physiology, Södersjukhuset, Stockholm, 2 Department of Cardiology, Karolinska University Hospital, Huddinge, Stockholm, 3 School of Technology and Health, Royal Institute of Technology, Stockholm, 4 Department of Clinical Physiology, Karolinska University Hospital, Huddinge, Stockholm, 5 Department of Cardiology, Karolinska University Hospital, Solna, Stockholm Purpose To compare the measurements of left ventricle ejection fraction (LVEF) with two-dimensional (2D) and real-time three-dimensional echocardiography (RT3DE) in relation to the visibility to assess whether RT3DE is superior to conventional 2DE with reasonable variability. Background 2DE is the most frequently used imaging modality for the evaluation of LV volumes and function due to its non-invasive nature, time- and cost-efficiency, and wide availability. Although 3D imaging of the LV can avoid the geometrical constraints of available 2D methods, 3DE may be more dependent on visibility to obtain accurate measures, and has not been fully implemented in clinical practice. Ameliorated imaging techniques and recent imaging analysis software have represented a substantial facilitation of 3D analysis, but the potential advantages of 3D over 2DE for the evaluation of LVEF have not been fully explored. Materials/Methods Forty-two (27 men and 15 women, 62±20 years of age) consecutive patients underwent 2DE and RT3DE using Vivid E9 (GE, Norway). LVEF by 2DE (Simpson s biplane mode, figure A) and RT3DE (automated analysis tool, 4D LVQ, figure B) was assessed off-line (EchoPAC, version , GE, Norway) by two observers to determinate interobserver variability. RT3DE images were graded according to the number of segment visualization in six basal, six mid and six apical segments (total: 1-18). A B Figure A. Determination of ejection fraction using Simpson s biplane formula. Figure B. Ejection fraction calculation using real-time three-dimensional echocardiography. Results The inter-observer variability for the total patient population with 2D and 3DE regarding EF was 7% and 5.7% respectively. When plotting number of visualized segments (x-axis) vs. coefficients of variability (yaxis) these plots revealed a lower variability of EF for 3D in patients with good visibility, whereas in patients with poorer visibility, EF determination by 2D exhibited less variation. Linear regressions revealed an intercept between 2D and 3D at 13 segments, corresponding to an inter-observer variability of 6.5% (figure 1). Thirty-one patients had a visibility of 13 segments or more. Within the latter group, an inter-observer variability of less than 6.5% was observed in 81% for the 3D analysis compared with 64% for the 2D analyses. The corresponding values in the group with <13 segments visualized, were 45% and 55% for 3D and 2D, respectively. Furthermore, whereas there were significant differences in EF between the two observers (p<0.05) for both modalities in the whole cohort, EF as determined by 2D remained significantly different between the two observers (P<0.005) also in the group with good visibility ( 13 segments), whereas EF as determined by 3D were not significantly different between the observers in this group. Conclusions Figure 1. Coefficient of variability vs. number of visualized segments assessed by 2D and Rt3DE. Using 3D echocardiography for LVEF determination may reduce inter-observer variability at a good visibility ( 13 segments).

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26 Var är infarkten lokaliserad? 1. Framvägg basalt 2. Framvägg midkammarnivå 3. Lateralt basalt 4. Lateralt midkammarnivå 5. Inferiort basalt 6. Inferiort midkammarnivå 7. Septalt basalt 8. Septalt midkammarnivå 9. Apikalt

27 2D 3D/4D +/-?? +++ Inarbetad teknik +++ Patologi i anatomisk context +++ Quick and Simple and most of the time good enough +++ Volymer: Beräkning Mätning +++ Tidsupplösning Spatialupplösning (+) Acquisition time