Learn to use this essential modality to assess cardiac function.
Gain a deep knowledge of strain rate imaging and where it can be applied with this online Diploma Course. Three course parts will walk you through step by step to learn this important modality 100% online and at your own pace – for beginners and advanced users.
COMPENDIUM CHAPTERS
Introduction
Why should you use Speckle Tracking Imaging and where can you apply it in your practice? Get answers to these questions by key experts and learn about overall deformation imaging and what it will bring in the future.
Limitations of Ejection Fraction
Ejection fraction is the holy grail of echocardiography? Often, it is not such a good parameter after all. Can strain imaging overcome some of the limitations?
Myocardial Mechanics
The work of the famous anatomist Torrent Guasp had great impact on our understanding of myocardial function. A thorough understanding of the different directions of contraction is key to our understanding of deformation imaging.
Deformation Imaging
How can strain be measured from a simple 2D image? What are the fundamental principles behind this method? What are we actually measuring? Watch this lecture to understand what Speckle Tracking Echocardiography is all about.
Image Acquisition and Analysis
Do you want to improve your clinical results with Speckle Tracking? If so, you will first need to know how to correctly acquire images. Find the most frequent mistakes highlighted in this chapter before we take you through a basic analysis of longitudinal strain.
Normal vs Abnormal
So now you have a perfect bullseye display and wonderful curves. But what do you do with them? What do all the values mean? Are there cut-off values? This chapter will teach you the typical features of a normal Speckle Tracking study and help you to distinguish it from both the hearts of athletes and left ventricular dysfunction.
Left Ventricular Hypertrophy
Left ventricular hypertrophy is among the most promising targets for deformation imaging. Learn more in this chapter about the specific patterns observable with Speckle Tracking and how the bullseye display mirrors the severity of left ventricular dysfunction.
Dilated Cardiomyopathy
Imagine you could detect left ventricular dysfunction at an early stage, even before ejection fraction drops. In this chapter, we show you how this can be done with Speckle Tracking and how longitudinal strain can be used to follow up on patients with dilated cardiomyopathy.
Cardio-Oncology
Speckle Tracking - a highly recommended tool to detect chemotherapy-induced cardiotoxicity. Learn what can happen after chemotherapy and how deformation imaging can help you to detect early-stage left ventricular dysfunction.
Dyssynchrony
Speckle Tracking has led to a renaissance of echo for the detection and analysis of patients with dyssynchrony. However, should we use STE for the selection of patients for CRT?
Coronary Artery Disease
Do you sometimes struggle to detect wall motion abnormalities? Speckle Tracking Echo can greatly assist you with this pathology. And, we will discuss its role in chronic stable CAD patients and acute coronary syndromes.
Valvular Heart Disease
LVF dictates our management of valvular heart disease. But is ejection fraction always a good parameter to monitor left heart function? In this chapter, we will discuss the role that strain plays in aortic stenosis, aortic regurgitation, mitral stenosis and mitral regurgitation.
ADVANCED CHAPTERS
Myocardial Mechanics
An important chapter that will set the stage for a better understanding of strain and its role in cardiovascular disease. Here you will learn how the heart muscle contracts, which parameters of cardiac function we can describe and which components of strain we can discern.
Methodology and normal findings
This chapter will provide you with in depth knowledge on what deformation is and which parameters can be measured. You will learn how Speckle Tracking works, which advantages it has to tissue Doppler and if values can be compared among different vendors. Finally, we will answer the question: Can we currently define normal values?
Instrumentation
How should a strain analysis be performed? Which buttons do I press? Which information can be obtained? We show you how to get the most out of a Speckle Tracking analysis on four different platforms (Canon/Toshiba, GE EchoPac, Siemens SC2000 and TomTec).
Thick myocardium
Here you will dig deeper into the field of longitudinal strain in patients with increased wall thickness. You will learn how this tool can help in the differential diagnosis of different causes of 'thick walls' such as hypertrophic CMP, hypertensive heart disease, amyloid heart disease and athletes heart. We will also discuss the prognostic value that Speckle Tracking echocardiography can provide and illustrate this through many cases.
Dilated cardiomyopathy
Speckle Tracking can have a large impact on the management of patients with dilated CMP. This chapters demonstrates why it is of value, how it can help to assess left ventricular function and which prognostic information it provides. Again, we show many case examples that will help you better understand how STE can be used in various settings including patients with HFpEF.
Cardio-oncology
With improvements in the survival of cancer, chemotherapy induced cardiotoxicity is a growing problem. In this chapter, you will discover the magnitude of this problem, which risk factors we can identify and what the mechanisms of cardiotoxicity are. You will also learn how STE should be implemented into your workflow to detect cardiotoxicity at an early stage.
Dyssynchrony
Speckle Tracking allows you to look at the timing of regional contraction. Therefore, STE can be used to study dyssynchrony in potential CRT candidates. This chapter will provide an overview on dyssynchrony and how the Speckle Tracking curves can help you to detect, and even quantify, the magnitude of dyssynchrony. Within specific cases we will provide many practical tips.
CAD
With STE it is possible to look at regional contraction in the setting of coronary artery disease. In this chapter we will discuss how acute coronary syndromes and chronic coronary artery disease influence longitudinal strain, what post-systolic thickening is and why it is important in coronary artery disease. Case examples will highlight the different patterns of regional longitudinal strain depending on the affected coronary territory and which prognositic information longitudonal strain can provide.
Stress Echo
If strain is able to detect ischemia, why not apply it during stress echocardiography? This chapter discusses the potential role and limitation of Speckle Tracking to detect coronary artery disease during stress echocardiography.
Aortic stenosis
Left ventricular function plays an important role in the management of patients with aortic stenosis, and Speckle Tracking is able to provide valuable information on top of ejection fraction. This chapter will explain why and show how this technique can be used to monitor patients and assess the prognosis.
Aortic regurgitation
Aortic regurgitation can cause left ventricular dysfunction. With Speckle Tracking, we can detect deterioration of left ventricular function at an early stage. How can this be helpful in aortic regurgitaion? What are the current guidelines for the management of patients with AR? Keynote lectures and cases studies will provide you these answers.
Mitral Regurgitation
Optimal timing of surgery in mitral regurgitation is critical for long term survival. In this chapter, we provide an overview of the current guidelines and show how Speckle Tracking can provide important additional information, both in structural and functional mitral regurgitation. Several case examples will help you better understand in which scenarios strain is helpful.
Right ventricular strain
Longitudinal deformation can also be measured in the right ventricle. This chapter will show you how such an analysis is performed, how strain compares to traditional parameters of right ventricular function, what the normal values are and in which clinical scenarios this information is of value. Numerous case examples will put this theoretical knowledge into a practical context.
Left atrial strain
The measurement of left atrial strain is a promising new way to study the function of the left atrium. It is easy to apply and could provide valuable information especially in patients with atrial fibrillation and diastolicdysfunction. In this chapter, we will discuss the physiology of the left atrium, technical aspects of the method, and what the prognostic significance is of a reduction in left atrial strain.
Future of Speckle Tracking
This chapter discusses the current limitations of the method and highlights the newest developments in ultrasound. Find out how Speckle Tracking can be used to directly image blood flow and and how high frame rate imaging could dramatically change the way we use Speckle Tracking in the future.
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EXPERT STATEMENTS
Fabian Knebel, MD, PhD
Senior Consultant Cardiology & Angiology | Charité, Berlin
Elena Surkova, MD, PhD
Royal Brompton Hospital, London
Ole Breithardt, MD
Medical University Vienna | AKH, Vienna
Steven J. Lester, MD
Consultant Cardiologist | Mayo Clinic, Scottsdale
Prof. Thomas Binder, MD
Consultant Cardiologist | Mayo Clinic, Scottsdale