How to Interpret Your Cardiovascular Image Reports (Echo ...
Transcript of How to Interpret Your Cardiovascular Image Reports (Echo ...
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How to Interpret Your
Cardiovascular Image Reports
(Echo Interpretation)
Eric Yu MD, MEd, FRCPC, FACC
University of Toronto
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► Faculty: Eric Yu, MD, MEd, FRCPC, FACC
► Relationships with commercial interests:
Grant/Research Support: None
Consultant: None
Speakers’ Bureau/Honoraria: None
Other: None
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Mitigating Potential Bias
All the recommendations involving clinical medicine are based on
evidence that is accepted within the profession
All scientific research referred to, reported, or used is in the support
or justification of patient care
Recommendations conform to the generally accepted standards.
Independent content validation
The presentation will mitigate potential bias by ensuring that data and
recommendations are presented in a fair and balanced way
Potential bias will be mitigated by presenting a full range of products
that can be used in this therapeutic area
Information of the history, development, funding, and the sponsoring
organizations of the disclosure presented will be discussed
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Objectives
Appropriate ordering and
interpretation of 2D echo
Appropriate ordering and
interpretation of stress echo
The role of LV systolic and diastolic
function in a patient with dyspnea
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What is echo?
Ultrasound modality, using high
frequency sound waves to create
images of your heart
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Needs an Echo. What would
you recommend?
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Advantages of Echo
Non-invasive
Painless
Prognostic information
Inexpensive compared with other
modalities
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Prognostic Value of Echo
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Limitations of Echo
Image quality
Operator dependency
Interpreter dependency
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Information Provided
Cardiac structure and function
– LV and RV function
– LV and RV wall thickness
– Valvular function (stenosis/regurgitation)
– Cardiac devices (artificial valves, PPM,
closure devices)
– Cardiac masses (clots, tumors)
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Normal
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67 y/o male with SOB
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77 y/o with chest pain and SOB
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Ordering an Echo
Anyone..
Who has ordered an echo this week?
What was the indication?
Any of the patients had a previous
echo?
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Ordering an Echo in 2016 and
Beyond
Ask yourself, how is this going to
change the management of the
patient
CCN 2015: ..use echocardiography if,
and only if, results have the potential
to influence clinical decisions and
patient management
Responsible utilization
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Indications for Echo
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Indications for Echo
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Indications for Echo
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Indications for Echo
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Stress Echocardiography
Echocardiogram performed both
before and immediatley after the
heart is being stressed
– Exercise
– Pharmacological injection
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Stress Echocardiography:
Rationale
Assessment of cardiac function at
exercise
CAD
Valvular Heart Disease
Hemodynamic measurements
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Stress Echo: Rest Images
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Stress Echo: Peak Exercise
Images
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Stress Echo: Rest Images
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Stress Echo: Peak Exercise
Images
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Advantages of Stress Echo
Non-invasive
Non-toxic/radioactive
Painless
Prognostic Information
Hemodynamic Information
– Valvular
– Pulmonary artery (RVSP)
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Stress Echo vs. Nuclear
Similar prognostic information
Advantages re: radiation,
hemodynamic markers
Caveat:
– Endocardial definition
– Image quality
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Prognostic Value of Stress
Echo
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Appropriate Interpretation
There are lots of labs…..
There is no standardization of
equipment
Sonographer experience
Reader experience
Ideally, Level II training, before
independent interpretation
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My Patient has Dyspnea…
Multiple causes: cardiac equivalents
vs. non-cardiac etiologies
Assessment of LV function
What is normal?
ASE 2015 Guidelines
– Males: 62 + 5 (52-72)
– Females: 64 + 5 (54-74)
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Cardiac Dyspnea
LV dysfunction
Ischemic Equivalent
Diastolic Abnormality
Pericardial Disorder
Other: Pulmonary Arterial/Venous
abnormality
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Heart = Pump
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LV Systolic Dysfunction
Systolic Heart Failure
Definition: an inability to expel
sufficient blood; decreased
ejection fraction
Definiton:“an elevation in
LVEDP with an increase in
LVED volumes”
Most common:
– Ischemia
– Cardiomyopathy (DCM)
– Valvular dysfunction
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67 y/o male with SOB
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LV Diastolic Dysfunction
Diastolic Heart Failure
Definition: An inability of the
heart to relax and fill
normally; ejection fraction is
preserved
Definition: “Elevated LVEDP
without an increase in LVED
volumes”
Etiologies:
– Hypertensive Heart
Disease
– Hypertrophy
– Hypertrophic
Cardiomyopathy
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67 y/o male with SOB
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Keys to determining what is
the problem
LVEF
LV Dimensions