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Tatiana Kuznetsova,University of Leuven,Belgium,The InGenious HyperCare European Network Excellence in phenotyping:,Assessment of left ventricular function,Outline,Systolic function,Diastolic function,Echocardiographic,protocol(JRP A3),LVF,Systolic function,Conventional echocardiography enables the assessment of LV dimensions,volumes,sphericity,index,and severity of mitral regurgitation;,HF due to systolic dysfunction is relatively easy to diagnose by echocardiography.(dilated left ventricle with a reduced ejection fraction),LVF,Radial function,Longitudinal,Circumferenti,a,l,Components of regional function,LVF,Without the longitudinal component,sarcomere shortening would lead to an EF 30%.,Tissue Doppler imaging,Tissue Doppler,Imaging,(TDI)makes it possible to specifically evaluate the longitudinal and radial components of regional LV systolic function.,Measurements of myocardial deformation with the Doppler technique have been,validated,using,microcrystals,and MRI,(,Urheim,S,Circulation 2000,;,Edvardsen,T,Circulation 2002,).,LVF,Basal segments of inferior and infero-lateral walls,AVC,MVO,Time,integration,Peak systolic SR,End-systolic S,Strain,Strain rate,AVC,MVO,LVF,Off-line analysis,SPEQLE:,Software Package for Echocardiographic Quantification,Leuven;version 4.06,Inter-observer differences in percent versus average of two readings,LVF,Bland and Altman,1986,Mean of 2 readings,Longitudinal S and SR by RWT,LVF,Mean values are adjusted;*,P,0.05*,P,0.001,Regional LV geometry,LVF,Wall stress related to:,Pressure,Shape,cavity size,Wall thickness,=P x R/2WT,Since R curvature is larger in longitudinal direction,the stress on longitudinal fibres is higher,they show decreased deformation first.,Systolic function,TDI,compared with conventional echocardiography,is a more sensitive method for the detection of LV systolic dysfunction,particularly in subjects with LV remodelling and normal EF.,Our observations underscore the importance of normal long axis function in maintaining a coordinated ventricular contraction.,The clinical utility of strain and strain rate in risk stratification or as therapeutic target remains to be established.,LVF,Diastolic function,About 50%of patients with new onset of HF do have a normal EF (HF with preserved EF).,HF with preserved EF is associated with a high mortality rate,comparable to that of patients with reduced EF.(,Bhatia R.S.,N,Engl,J Med 2006;,Bursi,F.,JAMA 2006,),Assessment of diastolic function requires conventional and Tissue Doppler Imaging,LVF,Transmitral blood flow vs pulsed Tissue Doppler Imaging,E,A,Ea,Aa,LVF,LVF,Mean of 2 readings,Inter-observer differences in percent versus average of two readings,Bland and Altman,1986,Determinants of TDI velocities,Stepwise analysis:,Ea:,age,BMI,DBP,LVMI;LV length,EF;,Aa,:,age,HR,DBP,LV length,EF;,Ea/,Aa,:,age,BMI,HR,DBP.,Intrafamilial,correlation coefficients(,P,0.0001,for all)were:,Ea:,0.43;,Aa,:,0.41;,Ea/,Aa,:,0.46.,LVF,Echocardiographic performance protocol,Echo,A single observer performs all,echocardiographic,examinations by means of Vivid 7 ultrasound scanner(GE,Vingmed,Horten,Norway),Standardized echocardiography scanning sequence(about 40 min,page 76-77 MOP JRP A3),Correct orientation of the ultrasound beam and imaging planes to LV structure and blood flow is essential,All,echocardiographic,examinations in a digital format are stored on a local network for off-line reading by two independent observers(,EchoPack,GE and SPEQLE,University of Leuven),Methods to limit echocardiographic measurement variability,Use echocardiography central reading laboratory:,a.Minimize number of readers,b.Monitor reader variability,c.Rapid communication with study sites on study quality.,Standardized“hands-on training of sonographers onsite.,Monitoring of sonographers for technical quality;encode study quality in database.,American Society of Echocardiography Recommendations for Use of Echocardiography in Clinical Trials.J Am Soc Echocardiogr 2004;17:1086-1119,Echo,Methods to limit echocardiographic measurement variability,Reading off-line strategies:,Batch read,when possible to minimize systematic temporal drifts;,Average multiple beats,(minimum of 3);,Single reader preferable,.,Establish acquisition and reader variability:,Test-retest,of small sample of participants,ie,same participant repeated over small interval,same machine,same,sonographer,same reader;,Blind duplicates for,inter-reader and intra-reader variability,assessment.,Echo,Katholieke Universiteit Leuven,B,JA Staessen,T Kuznetsova,T Richart,Jagiellonian University Cracow,PL,K Kawecka-Jaszcz,K Stolarz,M Loster,Medical University of Gdansk,PL,K Narkiewicz,W Sakiewicz,A Rojek,Universit degli Studi di Padova,I,E Casiglia,V Tikhonoff,Hospital Universitari Valencia,SP,E Lurbe,J Alvarez,Institute of Internal Medicine,RU,Y Nikitin,S Malyutina,A Ryabikov,Echo-centers,JRP A3,精品资料，祝您成功,
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