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New insights into myocardial function using echocardiography

Non-Invasive Imaging


 

“The music of (ultra)sound”

Speckle tracking technique is one of the major recent developments in echocardiography. A special session was devoted to exploring the technical background of this novel technique, to highlight its clinical potential and limitations and to discuss current and future directions.

Dr. J.U.Voight from Leuven, BE showed in an excellent introductory presentation the possibility to track all cardiac chambers and even valves using speckle tracking. While the traditional technique of tissue Doppler is angle dependent and therefore is capable of measuring only longitudinal strain from the apical views, speckle tracking can measure, in addition, circumferential and radial strain, the latter is a measure of muscle thickening, and also depict the more complex movements of torsion and rotation, which, until recently, could only be analysed by MRI. He emphasized that although RF based images may be accurate, for practical reasons gray scale images are more suited for clinical use.

Dr. T. Velle Halle from Oslo, NO presented the results of validation studies, as compared with sonomicrometry in animal models, MRI for clinical LV function and cardiac CT for LV volumes. He pointed out that this technique is based on specific mathematical calculations as well. The most widely used parameter is strain, which is the accepted measure of myocardial deformation. For this calculation, frame rate does not necessarily need to be high, although for some rapid changes in cardiac motion, higher frame rates are necessary.

Dr. M. M Becker from Aachen DE presented data on myocardial viability, ischemia and perfusion. He showed that speckle tracking technique has the potential to depict viable tissue, with reference to the gold standard technique – MRI. Initial studies with Dobutamine speckle tracking stress studies are promising, though more clinical data is needed to demonstrate superiority over currently used techniques. In addition, data in very fast heart rates is still lacking. Some initial data compared with contrast echo exist as well, depicting myocardial perfusion.

Finally, Dr. LE Sade from Ankara, TR, in a very elegant presentation showed that speckle tracking can provide very important information on diastolic function of the heart, in particular the analysis of untwisting. The technique has great potential for the analysis of different types of cardiomyopathy, the possibility to differentiate restrictive CMP from constrictive pericarditis, dyssynchrony – as a potential marker for CRT implantation and also valvular diseases such as mitral regurgitation and aortic stenosis.

In conclusion, though certainly more clinical data in large patient populations is needed, speckle tracking echocardiography is here to stay, it has truly great clinical potential and incorporation into 3D-4D imaging is expected in the near future.

References


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New insights into myocardial function using echocardiography

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.