Morcerf Course of Myocardial Deformation – Strain and Strain Rate 2020 (Videos)

Understanding Myocardial Deformation and Strain Rate: A Comprehensive Guide for Echocardiographers

Introduction

Echocardiography, a cornerstone of cardiac diagnostics, has evolved significantly with the introduction of Strain and Strain Rate measurements. These advanced techniques provide invaluable insights into myocardial function and enable the detection of subtle changes that may be missed by conventional echocardiographic methods.

General Concepts

– Deformation (Strain): Refers to the change in length or volume of the myocardium during a cardiac cycle. It can be measured in various directions, providing information about myocardial shortening, thickening, or rotation.

– Deformation Rate (Strain Rate): Measures the velocity of myocardial deformation, indicating the dynamic changes occurring during cardiac contraction and relaxation.

– Myocardial Deformation: Term used to describe the overall deformation pattern of the heart muscle, which can be assessed using Strain and Strain Rate measurements.

Essential Anatomical Knowledge

Understanding the anatomical landmarks of the heart is crucial for accurate interpretation of Myocardial Deformation. Key structures include the longitudinal axis, circumferential fibers, and radial fibers.

Physiological Considerations

• Band Contraction Sequence: Myocardial deformation occurs due to the sequential activation and shortening of myofibrils, resulting in a wave of contraction that propagates through the heart.

• Anatomical Relationship of Torsion and Longitudinal Velocities: Torsion, the twisting motion of the heart, is related to longitudinal velocities measured by Tissue Doppler.

• Anatomical Relationship of Torsion and Transverse Velocity Vectors: Torsion is also associated with transverse velocities, providing additional information about myocardial function.

Tissue Doppler Imaging

• Time Parameters: Velocity vectors can be analyzed over time to assess deformation patterns.

• How to Perform Color Tissue Doppler: Involves acquiring images in specific planes and analyzing the color-coded velocities.

• Use of Spectral and Color Tissue Doppler: Combined use of spectral and color Tissue Doppler provides detailed information about myocardial velocities.

• Initial Concepts of Color Tissue Doppler in Myocardial Deformation: Color Tissue Doppler enables visualization of Strain and Strain Rate by tracking tissue velocities.

Specific Strain and Strain Rate Measurements

• Strain Rate Study: Focuses on the velocity of myocardial deformation, providing insights into the mechanical properties of the heart.

• Strain Study: Measures the actual change in myocardial length or volume, aiding in the assessment of myocardial function and mechanics.

Speckle Tracking Echocardiography

• Types of Speckle Tracking: Various algorithms exist, including feature tracking, block matching, and optical flow.

• Initial Considerations for LV Deformation Study with Speckle Tracking: Appropriate image acquisition and tracking parameters are crucial for accurate measurements.

Assessment of LV Function with Speckle Tracking

• Analysis of Strain and Strain Rate Images and Curves: Images and curves derived from Speckle Tracking provide visual and quantitative information about myocardial deformation.

• Study with Different Views: LV function can be assessed from multiple perspectives, including the apical 4-chamber, long-axis, 2-chamber, and short axis views.

Assessment of RV and LV Function in Various Pathologies

• Right Ventricle Function: Strain and Strain Rate measurements can evaluate RV function in normal and pathological conditions.

• Valvular Lesions: Quantitative assessment of myocardial deformation can provide insights into the impact of valvular diseases on LV function.

• LV Hypertrophy and Infiltration: Strain and Strain Rate measurements aid in detecting subtle changes in LV function associated with conditions such as hypertension and infiltrative diseases.

• Dilated Cardiomyopathies: These measurements can assist in differentiating dilated cardiomyopathies from other conditions and assess myocardial performance.

• Ischemic Heart Disease: Strain and Strain Rate measurements enhance the evaluation of myocardial viability and dysfunction in patients with ischemic heart disease.

• Athletes: Myocardial deformation analysis can provide information about the physiological adaptations of the heart in athletes.

By understanding these concepts and techniques, echocardiographers can effectively utilize Strain and Strain Rate measurements to enhance the diagnosis and management of various cardiac conditions.