euroecho2010 dilated cardiomyopathy diagnosis moya 550

DILATED CADIOMYOPATHY AND DILATED CADIOMYOPATHY AND

JL Moya JL Moya MurMur

DIFFERENCIAL DIAGNOSIS DIFFERENCIAL DIAGNOSIS

Hospital Ramn y CajalHospital Ramn y CajalMadrid. Madrid. SpainSpain

I do not have any conflict of interest

EUROECHO CONGRESS - COPENHAGEN -TEACHING COURSE 2010

Classification of the Classification of the cardiomyopathiescardiomyopathies: a position statement from the : a position statement from the European Society of Cardiology Working Group on Myocardial and European Society of Cardiology Working Group on Myocardial and DericardialDericardial DiseasesDiseases. 2008. 2008

Familial Non Familial

DCM

Evidence of LV dilationImpaired LV contraction.

Coronary artery diseaseCoronary artery diseaseHypertensionValvular heart disease


INITIAL EVALUATION AND DIAGNOSIS

PROGNOSTIC EVALUATION

GUIDING AND MONITORING TREATMENTGUIDING AND MONITORING TREATMENT


Analysis of morphology and systolic functionAnalysis of morphology and systolic function

LV spherical dilationLV spherical dilationNormal or reduced wall thicknessNormal or reduced wall thicknessPoor wall thickeningPoor wall thickeningPoor wall thickeningPoor wall thickeningDyssynchronyDyssynchrony movementmovementAbnormal systolic parametersAbnormal systolic parametersFour chambers enlargementFour chambers enlargementFour chambers enlargementFour chambers enlargement

LVEDV > 112%; EF < 45%LVEDV > 112%; EF < 45%


Analysis of morphology and systolic function

Mitral Annulus Peak Systolic Mitral Annulus Peak Systolic VelocityVelocity

Mitral Annulus Peak Systolic Mitral Annulus Peak Systolic DisplacementDisplacement

SphericitySphericity indexindexmyocardial performance index myocardial performance index

dPdTdPdTPeak Systolic StrainPeak Systolic Strain


Analysis of diastolic function and filling pressure.Analysis of diastolic function and filling pressure.

TDI PVF LA vol.TDI PVF LA vol.Mitral filling patternMitral filling pattern

Recommendations for the evaluation of left ventricularevaluation of left ventricular diastolic function by echocardiography.

Nagueh SF Eur J EchocardiogrNagueh SF. Eur J Echocardiogr. 2009 Mar;10(2):165-93.

EUROECHO CONGRESS -COPENHAGEN - TEACHING

COURSE 2010

Analysis of diastolic function and filling pressureAnalysis of diastolic function and filling pressure

Dokainish H, Circulation. 2004 109(20) 2432 92004;109(20):2432-9.

EUROECHO CONGRESS -COPENHAGEN - TEACHING

COURSE 2010

Analysis of Analysis of valvularvalvular function: mitral regurgitationfunction: mitral regurgitationLV remodelingLV remodeling

posterior papillary Muscle displacement

Tethering of theMitral leaflet

excess of

III b , Carpentier valvular Tenting

Annulus dilation

Dyssynchrony


TentingTentingLV remodelingLV remodelinggg

PPMPPM despdesp

EROERO

PPM PPM despdesp

YiYi Ci l tiCi l ti

PPM PPM despdesp

YiuYiu. . CirculationCirculation. . 2000;102:14002000;102:1400--1406 1406

tentingtentingT tiT tiTentingTenting

M.R. M.R. severityseverity

SadeghpourSadeghpour J J CardiothoracCardiothorac SurgSurg. . 2008; 3: 54 2008; 3: 54

Analysis of pulmonary pressure and right Analysis of pulmonary pressure and right ventricular functionventricular function

PSPCATE

DOPPLER

Kaul S, JM. Am Heart J 1984;107:526531.


IDIOPHATIC HCM

SARCOIDOSIS CHAGASAMYLOIDOSISAMYLOIDOSIS

Thomas DE. European Journal of Echocardiography (2009) 10, iii15iii21


Left ventricular nonLeft ventricular non--compactioncompaction

Family screening200 patients with cardiac failure

anticoagulation,

protective device

24% satisfy one criteria

5 /60 (8%) control subjects protective device therapy

5 /60 (8%) control subjects satisfy some criteria.

Kohli. Eur Heart J 2008; 29:8995

E F

Systolic function Systolic function

TDIE.F. TDI

Mitral annulus systolic velocity(TDI)(TDI)

SERRAY JACC 1986;7:729Wang JACC 2003, 41: 820-826

SphericitySphericity indexindex DyssynchronyDyssynchrony

L

D

S h i it i d L / DSphericity index = L / D

Cho GY JACC 2005;46:2237 43Tischler. JACC. 1993;22,3, 751-757

Cho GY,. JACC 2005;46:2237 43.

DIASTOLIC MITRAL FILLING

Diastolic function Diastolic function DIASTOLIC MITRAL FILLING

Mller JACC, 2000; 36:1841-1846Alameda M , Moya, JL Rev Esp Cardiol 2002;55(4):372-82

Campolla. JACC 38,, 2001, 1675-1684Alberto Garca-Lled, Jos L. Moya, Rev Esp Cardiol. 2005;58(9):1029-36

Hillis GS, J Am Coll Cardiol 2004;43:360 7.Beinart J Am Coll Cardiol, 2004; 44:327-334,Mller Circulation. 2003;107:2207

The prognostic capacity of echo increases asSystolic function , Diastolic function Filling pressures are introduced in the model

LAV increment the prognostic information of Clinical , systolic and diastolic function

Filling pressures, are introduced in the model

Mitral regurgitation. Mitral regurgitation. Ischaemic dilated cardiomyopathy

Asynptomatics.Ischaemic dilated cardiomyopathy

Grigioni et al. Circulation 2001; 103:1759-64 Grigioni et al. JACC 2005,45(2)260-7.

i h i dil t d di thTenting area is an independent predictor of mortality and hospitalizations in patients with NICMP and FMR.

non-ischaemic dilated cardiomyopathy

Karaca O, Eur J Heart Fail. 2010 Nov 23.

Right ventricular function and pulmonary pressureRight ventricular function and pulmonary pressure

Vel de IT < 2,5 m/sg

Vel de IT > 2,5 m/sg

Stefano Ghio. MD Am J Cardiol. 2000 Apr 1;85(7):837-42.

Abramson Ann Int Med 92:116:888

Medical Therapypy

Mitral repairMitral repair

Anticoagulation Therapy

Resynchronization Therapy

ICD Therapy


F C IIIF C III--IVIVF.C. IIIF.C. III IVIVEF < 35% EF < 35%

QRS > 120msQRS > 120msQRS > 120msQRS > 120ms

?%?%NO THERAPYNO THERAPY

2020--30% 30% RST THERAPYRST THERAPY

NO RESPONSE NO RESPONSE NO RESPONSENO RESPONSE

ECHOCARDIOGRAPHY

SeptSept.

L. Wall

BaxBax JJ, Am J JJ, Am J CardiolCardiol 2003; 92:12382003; 92:1238

SLWD 60SLWD > 60 ms

> 140 ms

SPWMD > 130 ms LVFT < 40%

> 140 ms

PROSPECTPROSPECT

No single mechanical echocardiographic measure of dyssynchrony may be recommended to improve patient selection for resynchronization therapy.

Method to determine the mechanical dyssynchrony needs further development.

Chung Circulation 2008; 117:2608

1 2

3 4

WE NEED A METHODWE NEED A METHOD

--DetectDetect dyssynchronydyssynchrony and respondersand respondersDetect Detect dyssynchronydyssynchrony and respondersand responders--Low variabilityLow variability--Better results than obtained with QRS durationBetter results than obtained with QRS duration--With results confirmed in prospective studiesWith results confirmed in prospective studiesp pp p

2010 F d U d t f ESC G id liG id li2010 Focused Update of ESC Guidelines Guidelines on device therapy in heart failure. on device therapy in heart failure. European Heart Journal (2010) 31, 26772687


For Simpsons rule, Bland-Altman limits of agreement p , g(95% CI) ranged from LVEF 7% to 25% (median 18%);

Why do no respond?Why do no respond?

Improper patient selection Improper patient selection.

No mechanical asynchrony.

Improper position the electrodeImproper position the electrode.

Advanced state of cardiomyopathy

/incorrect AV/VV delay optimization

Dysfunction device,

displacement of the cable.

Arrhythmias, spontaneous or mediated by the PM

How to optimize dyssynchrony with echo?

1.- program different AV or VV delays

septal2.- analyze their repercussion in:

-SYNCHRONYLat. Wall

SYNCHRONY-SYSTOLIC FUNCTION: AORTIC VTI-DIASTOLIC FUNCTION: MITRAL FILLING.

RV20LV LV20RV LV40RVLV00RVbasal

TDI vel

TTTT

Strain

Kedia. Am J Cardiol 2006;98:780 785

Boriani Am Heart J 2006;151:1050-8. (RHYTHM II )

Vidal B, Am J Cardiol 2007;15:1002

ASE EXPERT CONSENSUS STATMENT

Current studies have shown thas subsets of patients do acutely benefit from p yV-V optimization, but long term benefit has yet to be determined

GorcsanGorcsan III JASE 2008;21: marzo: 191III JASE 2008;21: marzo: 191--245245

Echocardiography is essential in patients with SD and DCM:

-Describe the typical features and associated findings of patientswith Dilated Cardiomyopathy.

-Assess systolic and diastolic function, mitral regurgitation, and RV function.

- Identify echo marker of adverse prognosis

- is useful in guiding and monitoring therapeutic management.

euroecho2010 dilated cardiomyopathy diagnosis moya 550

Documents

teaching course

analysis of analysis

euroecho congress copenhagen

valvularvalvular function

reduced wall thicknessnormal

mitral regurgitationfunction

filling pressuredokainish

dilated cadiomyopathy