STRAIN AND STRAIN RATE – COURSE OF MYOCARDIAL DEFORMATION
Important General Concepts
DEFORMATION (STRAIN) AND DEFORMATION RATE (STRAIN RATE) (7 min)
Initial concepts about strain and strain rate. Longitudinal, Circumferential and Radial Strain. Tethering . Shear Strain .
ANATOMICAL KNOWLEDGE INDISPENSABLE FOR THE STUDY OF MYOCARDIAL DEFORMATION. (7 min)
Cardiac anatomy seen from a totally different point of view. It is impossible to start a class on cardiac anatomy relevant to the study of myocardial deformation and not to mention the works of Torrent-Guasp. Muscle bands. Downward and upward fibers .
PHYSIOLOGY I - BAND CONTRACTION SEQUENCE (10 min)
With this knowledge, based on the muscular bands of Torrent-Guasp, it will be possible to relate the electrical and mechanical physiological activity of the cardiac muscle to these bands. Old concepts to which we have been accustomed for many years, must be changed.
PHYSIOLOGY II - ANATOMICAL RELATIONSHIP OF TORRENT GUASP AND LONGITUDINAL VELOCITIES VECTORS (9 min)
Analysis of the pre-ejection time; isovolumetric contraction period; ejection time; isovolumetric post-ejection period; diastasis and atrial contraction using apical views.
PHYSIOLOGY III - ANATOMICAL RELATIONSHIP OF TORRENT GUASP AND TRANSVERSE VELOCITY VECTORS (5min)
Analysis of pre-ejection time; isovolumetric contraction period; ejection time; isovolumetric post-ejection period; diastasis and atrial contraction using short axis views.
Colored Tissue Doppler
TIME PARAMETERS (4 min)
First of all, we have to obtain the moments of the opening and closing of the aortic and mitral valves .
HOW TO PERFORM COLOR TISSUE DOPPLER (15 min)
Spectral pulsed tissue Doppler. Intensity and velocity filters. Color two-dimensional tissue Doppler. Curved anatomical M mode of tissue color Doppler. VTI (velocity time imaging). TSI (tissue synchronization imaging). TT ( tissue tracking). SI (strain imaging, SRI (strain rate imaging). Position of ROI ( region of interest ).
USE OF MOBILE ROI (6 min)
Variations of curves depending on the position of the ROI. Inter- and intra- observer variations . Possibilities of errors. Differences between the analysis of amplitude and time of maximum peaks. You should learn derivative and integral. Ways to fix a mobile ROI.
LV function with spectral and color Tissue Doppler
USE OF SPECTRAL TISSULAR DOPPLER (17 min).
Evaluation of the velocityof the mitral annulus. S’ wave. Differences between the lateral and septal wall. Time measurements using the anullus spectral Doppler. Electromechanical range. Proto systolic period. Action of the Torrent Guasp’s circumferential band. Isovolumetric contraction period. Isovolumetric period after ejection.
INITIAL CONCEPTS OF COLORED TISSUE DOPPLER IN THE STUDY ON MYOCARDIAL DEFORMATION (30 min)
Velocitycurves; displacements; strain rate and strain.
MYOCARDIAL DEFORMATION: DETAILS FOR STRAIN RATE STUDY (4 min)
Important details in the images and strain rate curves
MYOCARDIAL DEFORMATION: DETAILS FOR STRAIN STUDY (7 min)
Important details in the images and curves of the strain
PROBLEMS (6 min)
Angulation; reverberation; temporal resolution; frame frequency, etc. How to solve.
TISSUE DOPPLER CURVED M MODE (13 min)
Very important! Even with speckle tracking the assessment with color tissue Doppler is essential. Especially the detailed analysis on the strain rate. Often better than speckle tracking for certain details.
VE function with Speckle Tracking
DIFFERENT TYPES OS SPECKLE TRACKING (6 min)
There are two kinds of speckle tracking. The block matching and the optical flow. Let us study their differences.
INITIAL CONSIDERATIONS FOR THE STUDY OF LV DEFORMATION WITH SPECKLE TRACKING (7 min)
Detailed information to the use of LV images and curves with Speckle Tracking. Frame frequency; heart rate; temporal resolution; lateral resolution, etc.
INITIAL ANALYSIS OF STRAIN AND STRAIN RATE IMAGES AND CURVES (9 min)
How to analyze the images, curves and curved M mode obtained with block matching type speckle tracking .
STUDY WITH THE APICAL 4CHAMBER VIEW (7 min)
Initial assessment with the apical 4chamber.
STUDY WITH APICAL LONGAXIS VIEW (9 min)
Initial assessment from the 3-chamber longitudinal apical.
STUDY WITH APICAL 2CHAMBER VIEW (9 min)
Initial assessment with apical 2chamber. Bull’s eye analysis now.
STUDY WITH SHORT AXIS VIEWS (15 min)
Mitral, papillary muscles and LV apex level. Rotations, Twist, Torsion and Rate of Twist
SOME FINAL DETAILS (5min)
Pre-stretch index, post-systolic index, ventricular desynchronization.
RV function with spectral Doppler, colored Tissue Doppler and Speckle Tracking. Normal and in Different Pathologies
STUDY OF THE RIGHT VENTRICLE FUNCTION (26 min)
Use of spectral Doppler S’ of the tricuspid ring compared to TAPSE; Color tissue Doppler and Speckle Tracking in normal RV and tricuspid regurgitation, pulmonary arterial hypertension, pulmonary stenosis, carcinoid syndrome, dilated cardiomyopathy, RV arrhythmogenic dysplasia
LV function with spectral Doppler, colaorticor Tissue Doppler and Speckle Tracking in valvular lesions
MITRAL REGURGITATION (8 min)
Levels of LV dysfunction. Best time for surgery in asymptomatic patients. Perspective of postoperative LV function return.
AORTIC STENOSIS (15 min)
Levels of LV dysfunction. Best time for surgery in asymptomatic patients. Perspective of postoperative LV function return.
AORTHIC REGURGITATION (4 min)
Levels of LV dysfunction. Best time for surgery in asymptomatic patients. Perspective of postoperative LV function return.
LV function with spectral Doppler, colored Tissue Doppler and Speckle Tracking in heart disease with hypertrophy or infiltration of the LV walls
HYPERTENSIVE CARDIOPATHY (15 min)
Levels of LV dysfunction compared to the ejection fraction. Scattering of peaks. Follow-up of the hypertensive patient. Detection of fibrosis in the LV walls.
ASYMMETRIC HYPERTHROPHIC MYOCARDIOPATHY (9 min)
With or without subaortic obstruction. With mid-ventricular obstruction. Yamagushi.
AMYLOIDOSIS (7 min)
Reasonably characteristic aspect in the Bull’s eye of speckle tracking.
FRIEDREICH ATAXIA (3 min)
Differential diagnosis with hypertensive heart disease, hypertrophic cardiomyopathy and amyloidosis.
LV function with spectral Doppler, colored Tissue Doppler and Speckle Tracking in LV dilatation cardiomyopathies
DILATED MYOCARDIOPATHIES (8 min)
Study of the diverse causes of dilated cardiomyopathies.
VIROTIC MYOCARDITIS (5min)
Acute stage and after clinical improvement
DILATED MYOCARDIOPATHY WITH BCRE (9 min)
It is important to distinguish BCRE changes with and without myocardiopathy. Ventricular desynchronization.
MYOCARDIOPATHY WITH LV NON-COMPACTION (4 min)
Do you have any specific signs for studying myocardial deformation? I believe so.
ENDOMIOCARDIOFIBROSE (2 min)
Some findings may be characteristic.
CHAGASIC CARDIOPATHY (2 min)
Chagasic aneurysm. Could non-involvement of the septal-antero-basal walls in their declared form be used in the differential diagnosis of dilated cardiomyopathies? Good topic for a study.
SARCOIDOSIS (2 min)
Differential diagnosis can be mainly with coronary disease.
LV function with spectral Doppler, colored Tissue Doppler and Speckle Tracking in Ischemic Heart Disease
INITIAL CONSIDERATIONS IN ISCHEMIC CARDIOPATHY (8min)
Signs indicating probable ischemia. Problems with segmental assessment of LV walls.
LV ANEURISM WITH THROMBI (3min)
A case of apical aneurysm with a thrombus.
POSTERO-LATERAL INFARCTION (4min)
A case of postero-lateral.
INFERIOR and ANTERIOR INFARCTION (8 min)
A case of inferior and anterior walls infarction.
INFERIOR, POSTERIOR AND RV WALLS FIBROSIS (3 min)
A case of fibrosis of the inferior and posterior walls and also of the RV.
ANTEROSEPTAL WALL FIBROSIS (2 min)
A case of anteroseptal wall fibrosis.
INFERIOR AND POSTERIOR WALLS FIBROSIS (3 min)
A case of fibrosis of the inferior and posterior walls.
STENT FOR PREVIOUS ANTERIOR WALL INFARCTION (4 min)
A case of stent for LAD after infarction.
LV ANEURISM (2 min)
A case of LV aneurysm.
LV function with spectral Doppler, color Tissue Doppler and Speckle Tracking in Athletes
MYOCARDIAL DEFORMATION IN ATHLETES (4 min)
Strength and endurance athletes have different deformations.
Video classes can be accessed from any computer, tablet, and cell phone, for a period of 180 days.
