Siffror och decimaler hur

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1 Användarmöte 2011 Siffror och decimaler hur mäter vi egentligen?

2 Resultat Fall 5 FRÅGA_UPPGIFT Antal individuella Antal kliniksvar Totalt Medelvärde totalt/kliniksvar SD Totalt CV Totalt Min Max Bakväggstjocklek, diastole ,5/16,3 3,5 20,9 9 25,0 Septumtjocklek, diastole ,4/13,2 2,8 20,9 8 20,6 Vä-kammare diastolisk diameter ,6/37,6 4,9 13, ,0 Vä-kammare systolisk diameter ,7/20,0 5,6 28, ,0 Bakgrund: Man med diagnos hypertrofisk kardiomyopati. Uppgift: Mätning av vänsterkammardiameter och väggtjocklek. 1 a) mät septumtjocklek och bakväggstjocklek (mm). b) beskriv var mätningen gjordes ( bild 1,2,3 eller 4). 2 a) mät VK diameter i diastole och systole. b) beskriv var mätningen gjordes ( bild 1,2,3 eller 4). 3 Skriv ned utifrån vilken referens du/ni använt som stöd till det sätt du/ni valt att göra.

3 Resultat Fll5 Fall

4 2D eller M mode?

5 2D eller M mode?

6 2D eller M mode?

7 Undvik false tendon och moderatorband

8 Endast i syfte att styrka eller utesluta Endast i syfte att styrka eller utesluta tidigare misstanke på patologi

9 ?

10 Heart October; 91(10): Heart New aspects of the ventricular septum and its function: an echocardiographic study P Boettler, et al

11 Höger kammare Septum i diastole Vänster kammare diastole Vänster kammare i systole Bakvägg i diastole Pappilar Endokard Epikard EKG

12 Echocardiographic Determination of Left Ventricular Mass in Man Anatomic Validation of the Method RICHARD B. DEVEREUX, M.D., AND NATHANIEL REICHEK, M.D. Circulation Apr;55(4):613-8

13 Echocardiographic Determination of Left Ventricular Mass in Man Anatomic Validation of the Method RICHARD B. DEVEREUX, M.D., AND NATHANIEL REICHEK, M.D. Circulation Apr;55(4):613-8

14 Hur mäter ni?

15 Resultat Fll5 Fall Övervägande 2D användning i publiken ASE,EAE rek. Otto, A Olsson, Feigenbaum, Henry, lokala rutiner

16 ASE and EAE Recommendations for chamber quantification*: A Report from the American Society of Echocardiography s Guidelines and Standards Committee and the Chamber Quantification Writing Group, Developed in Conjunction with the European Association of Echocardiography, a Branch of the European Society of Cardiology M-mode + Reproducible + High frame rates - Beam orientation frequently off-axis + Wealth of accumulate data - Single dimension may not be representative in distorted ventricles + Most representative in normally shaped ventricles 2-D guided + Assures orientation perpendicular - Lower frame rates - Single dimensoins only Alternatively, chamber dimension and wall thicknesses can be acquired from the parasternal short-axis view using direct 2D measurements or targeted M-mode echocardiography provided that the M-mode cursor can be positioned perpendicular to the septum and LV posterior wall.

17 The direct 2D minor-axis dimensions are smaller than the M mode measurements with the upper limits of normal of LVIDd being 5.2 versus 5.5 cm and the lower limits of normal for fractional shortening (FS) being 0.18 versus Normal systolic and diastolic measurements reported for this parameter are cm and cm, respectively. 2,18 Sahn DJ, DeMaria A, Kisslo J, Weyman A. Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation 1978;58: Triulzi MO, Gillam LD, Gentile F, Newell J, Weyman A.Normal adult cross-sectional echocardiographic values: linear dimensions and chamber areas. Echocardiography 1984; 1:

18 M mode echocardiography J Am Soc Echocardiogr Mar;23(3):240 57; Role of M mode technique in today's echocardiography. Feigenbaum H. M mode echocardiography is considered to be obsolete by many. The technique rarely is included in American Society of Echocardiography standards documents, except for M mode measurements, which have limited value. The superior temporal resolution of M mode echocardiography is frequently overlooked. Doppler recordings reflect blood velocity, whereas M mode motion of cardiac structures reflect volumetric blood flow. The 2 examinations are hemodynamically complementary. In the current digital era, recording multiple cardiac cycles of two dimensional echocardiographic images is no longer necessary. However, there are times when intermittent or respiratory changes occur. The M mode technique is an effective and efficient way to record the necessary multiple cardiac cycles. In certain situations, M mode recordings of the valves and interventricular septum can be particularly helpful in making a more accurate and complete echocardiographic cardiac assessment, thus helping to make the examination more cost effective.

19 J Am Soc Echocardiogr Mar;23(3):240 57; Role of M mode technique in today's echocardiography. Feigenbaum H.

20 M mode recording showing an exaggerated septal diastolic dip (arrow) in a patient with mitral stenosis. This finding highlights hli h the fact the RV filling is unimpeded d while the stenotic mitral valve restricts LVfilling. B, This recording is taken from a patient with severe pulmonary hypertension and severe tricuspid regurgitation. The RV volume overload produces an upward motion of the septum immediately after ventricular depolarization (vertical line), because the septum is flattened toward the left ventricle in diastole and pops out with onset of systole. The second finding is a very exaggerated diastolic dip (arrow). J Am Soc Echocardiogr Mar;23(3):240 57; Role of M mode technique in today's echocardiography. Feigenbaum H.

21 Septal motion in a patient with LBBB. The characteristic M mode finding with LBBB is a downward and then upward motion of the septum (first arrow, early systolic beak ) shortly after electrical depolarization. The septum moves paradoxically or toward the right ventricle during ventricular ejection of blood. The diastolic dip (second arrow) is frequently exaggerated. There is also delayed upward motion of the posterior wall. J Am Soc Echocardiogr Mar;23(3):240 57; Role of M mode technique in today's echocardiography. Feigenbaum H.

22 Interventricular septal motion in a patient with constrictive pericardititis. There is a prominent early diastolic dip (left arrow). Now there is also a second diastolic dip (right arrow). This illustrates how septal motion reflects filling of the 2 ventricles. Because the free walls of the ventricles are not free to expand properly, the chambers appear to fill alternately through changes in septal motion. B, M mode recording of the same patient after pericardial stripping and relief of the constriction. Septal motion is now normal. J Am Soc Echocardiogr Mar;23(3):240 57; Role of M mode technique in today's echocardiography. Feigenbaum H.

23 Effect of pericardial repair after aortic valve replacement on septal and right ventricular function Lindqvist P, Holmgren A, Zhao Y, Henein MY. Int J Cardiol Nov 25. [Epub ahead of print]

24 Icke publicerat data från 70 hjärtfriska individer Paired Samples Statistics Mean N Std. Deviation Std. Error Mean Pair 1 IVSD2D 9, ,789,214 IVSDMM 9, ,931,231 Pair 2 PWTD2D 9, ,679,202 PWTMM 8, ,868,225 Paired Samples Test Paired Mean Std. Deviation Std. Error Mean 95% Confidence Interval of the Difference Lower Upper t DF p Pair 1 IVSD2D IVSDMM,240 1,737,208,174,654 1,156 69,252 Pair 2 PWTD2D PWTMM,251 1,886,227,202,704 1,105 68,273

25 Icke publicerat data från 70 hjärtfriska individer Paired Samples Statistics Mean N Std. Deviation Std. Error Mean Pair 1 LVDD2D 46, ,340,638 LVDDMM 49, ,089,728 Pair 2 LVSD2D 29, ,507,658 LVSDMM 29, ,183,500 Paired Samples Test Paired Differences Mean Std. Deviation Std. Error Mean 95% Confidence Interval of the Difference t df Sig. (2 tailed) Lower Upper Pair 1 LVDD2D LVDDMM 3,539 5,207,622 4,780 2,297 5,686 69,000 Pair 2 LVSD2D LVSDMM,284 5,125,613 1,506,938,464 69,644

26 Förslag till rekommendationer I 1. Om möjligt använd M-mode vid mätning av vänster kammar diameter samt väggtjocklek 2. Optimera bildförstärkning, sweep speed, korrekt vinkel, notera vid lokal förtjockning Septum i diastole Vänster kammare diastole Bakvägg i diastole Höger kammare Vänster kammare i systole Pappilar Endokard Epikard EKG

27 Förslag till rekommendationer II 3. Om M-mode inte är användbar, gör 2D mätning av vänster kammar diameter samt väggtjocklek. 4. Om PLAX eller SAX bild inte är möjlig att få kan 2D uppskattning från 4 kammarbild/subcostalbild göras OBS! värden från dessa projektion är inte jämförbara med värden från PLAX eller SAX projektioner Sammanställning av information viktig! 5. Beskriv hur mätningen är utförd 6. Hänvisa till relevanta referensvärden 7. Decimaler? Ej rek i kliniskt bruk. 8. Ange bildkvaliteten

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