Myocardial deformation imaging:
from tissue Doppler to speckle tracking

Course directors: Luigi P. Badano, MD, Denisa Muraru, MD

Rationale

mail Myocardial function is a strong outcome predictor, with a major impact on the medical decision. Therefore it should be quantified with an accurate and sensitive echocardiographic method. Left ventricular ejection fraction (LVEF), the most common marker used for LV systolic function assessment has wide limitations in detecting myocardial dysfunction, especially in its early stages. Acute and chronic cardiac ischemic disease, valvular heart disease, cardiomyopathies, diabetes mellitus and hypertension are just a few of the cardiovascular diseases presenting early alterations of the cardiac geometry and function, which can not be usually detected by the conventional echocardiographic parameters. Therefore, real time ultrasound techniques that provide a measure of myocardial function emerged as a necessity to detect subclinical involvement of the myocardium in various cardiac conditions.
Non-invasive quantification of global and regional myocardial function using new echocardiographic techniques, such as Tissue Doppler Imaging (TDI), and derived Strain (S) and Strain Rate (SR) echocardiography offered new ways to quantify global and regional left and right ventricular function and to improve the accuracy and reproducibility of conventional echocardiography studies.
mail TDI detects local myocardial motion and, based on myocardial wall velocities, can provide a quantification of the myocardial function. However, TDI has several limitations, being influenced by cardiac and translational motion.
Speckle tracking echocardiography (STE) overcomes some of these limitations. It allows quantification of the myocardial deformation at a regional and global level by tracking the grey endocardial markers, so called speckles, being less susceptible to translational and angle- dependent and errors. Global deformation of the cardiac chambers can now be assessed by global longitudinal strain, which proved an effective method for quantifying global left ventricular function, particularly in patients with extensive wall motion abnormalities.
TDI and STE are now available on most modern cardiac ultrasound systems and can be used during a routine echo examination to complement ejection fraction calculation for a comprehensive assessment of cardiac chamber function.

Purposes

To offer basic and advanced theoretical knowledge about myocardial deformation, assessed by new echocardiographic techniques (TDI and STE).
To offer practical training in TDI and STE, with application into the clinical practice, in order to help echocardiographers who wish to implement deformation imaging in the routine of their echo-lab.

Design

A 3-day intensive theoretical and practical course with theoretical lessons in the morning and hands-on sessions in the afternoon has been organized.

Course language

English (no translation will be available)

Venue

Department of cardiac, thoracic and vascular sciences,
University of Padua, Medical School,
Via Giustiniani 2,
35128 Padua, Italy

Learning Objectives

Those who will attend will receive a comprehensive overview on state-of-the-art tissue Doppler and speckle tracking echocardiography.
Practical sessions will focused on how to acquire images suitable for deformation analysis and how to perform quantitative analyses at workstations.
Important! The practical sessions will be performed using MyLab echo scanner and MyLab Desk (ESAOTE) workstation only.

Teaching material and tools

Suggested readings

  1. Badano LP, Galderisi M, Muraru D, Mondillo S. “Speckle tracking echocardiography”, MB&Care, Livorno; 2011 (Book in Italian)
  2. Marwick TH, Yu C-M, Sun JP. Myocardial imaging. Tissue Doppler and speckle tracking. 2007, Blackwell Publishing

THEORETICAL LESSON PROGRAMME

Theoretical Sessions from 9:00 AM to 12:00 PM, from Monday to Wednesday

Day1 - PRINCIPLES AND METHODOLOGY

9:00 – 9.30
Introduction. Why do we need myocardial velocity imaging and strain?

9:30 - 10:00
Myocardial fiber architecture and the link with left ventricular mechanics

10:00 - 11:00
Myocardial function analysis by echocardiography (Part I) - Tissue Doppler Imaging (TDI): Definition and general principles about velocity, displacement, strain and strain rate - On-line and off-line TDI - One-dimensional strain by tissue Doppler

11:00 - 12:00
Myocardial function analysis by echocardiography (Part II) - Speckle-tracking echocardiography (STE): General principles of 2D speckle tracking echocardiography - Definition of strain and strain rate - Regional and global strain - Longitudinal, radial and circumferential strain - Twist and untwist, torsion, twist rate and untwist rate

Day2 - CLINICAL APPLICATIONS 1

9:00 - 9:30
Normal heart - Normal sequence of cardiac events - Normal strain and strain rate patterns - Reference values: left and right ventricle, left atrium

9:30 – 10:00
Thick heart - Athletes - Hypertensive heart disease - Hypertrophic cardiomyopathy - Infiltrative cardiomyopathies - Endocrine disorders

10:00 - 11:00
Hidden myocardial dysfunction - Heart valve diseases - Cardiotoxicity - Heart transplant

11:00 - 12:00
Failing heart - Additive prognostic value - LV dyssynchrony

Day 3 - CLINICAL APPLICATIONS 2

9:00 - 10:00
Ischemic heart - Myocardial infarction - Chronic ischemic heart disease - Myocardial viability - Stress echocardiography

10:00 - 11:00
Right ventricular function - Why do we need it and how to do it? - Arrhythmogenic right ventricular cardiomyopathy - Pulmonary hypertension - Before and after cardiac surgery

11:00 - 11:30
Left atrial function - Why do we need it and how to do it? - Atrial fibrillation - LV diastolic dysfunction

11:30 – 12:00
Practical issues and future developments - Technical challenges - Intervendor reproducibility - Three-dimensional strain by speckle-tracking echocardiography

Registration fees:

Theoretical and practical sessions: 1500€

Two seats for theoretical and practical sessions will be reserved to EACVI Club 35 members with a 50% discount on the registration fee.

NEXT COURSES STARTING DATES

2014 October 8th-10th

For further information, contact mail Ms Barbara Hildenbrand or download download Brochure for 2014 Courses.