This guideline recommends, when practicable, use of longitudinal strain imaging (GLS) and three-dimensional (3D) evaluation of ventricular size and function as part of the standard TTE examination – JASE December 2018

1. Philips Advanced Features of Echocardiography

2. Speckle tracking and 3D Evaluation

3. This guideline recommends, when practicable, use of longitudinal strain imaging (GLS)
and three-dimensional (3D) evaluation of ventricular size and function as part of the
standard TTE examination – JASE December 2018

4. LV Global longitudinal Strain
LV Global longitudinal strain (GLS) is the optimal
parameter of deformation for the early detection of
subclinical left ventricle (LV) dysfunction. It is
increasingly recognized as a more effective technique
than conventional ejection fraction (EF) by itself in
detecting subtle changes in LV function and predict
outcomes

5. Auto Strain LV
 One-button push for GLS measurement
 Fast speckle tracking on 3 apical views at once reduces the time needed for
measurement
 Highly validated vs. TOMTEC 2D CPA

6. LA Strain
LA strain is used to evaluate patients with
heart failure on both reduced and preserved
ejection fraction, especially evaluating
diastolic function

7. Auto strain LA
 AutoStrain LA provides fast, accurate and reproducible LA strain
measurements
 Measurements: LA GLS at conduit, reservoir and contraction phases
Importance of LA strain:
 Detects subclinical LA dysfunction in presence of normal LA size
 May improve the diagnosis of diastolic dysfunction
 Is independently associated with outcomes in patients with HFpEF

8. Auto Strain LA

9. Auto Strain LA

10. RV strain
RV strain provides additional information
for evaluating RV function on patients with
pulmonary artery, ischemic, congenital
diseases and heart failure

11. Auto strain RV
 AutoStrain RV provides fast, accurate and reproducible RV strain
measurements
 Measurements: RV free wall and global strain
Importance of RV strain:
 Is a predictor of progression of AF from paroxysmal to persistent AF
 Predicts AF recurrence after catheter ablation
 Provides additional risk stratification for stroke and may be useful to guide
decisions regarding anticoagulation

12. Auto Strain RV

13. Dynamic Heart ModelA.I.
Dynamic HeartModel (DHM):
▪Phasic display of the volume changes during cardiac cycle
▪Dynamics of the heart displaying moving contours for Left Ventricle (LV)
and Left Atrium (LA)
Measurements:
▪LV 3D EF, LV volumes, LV mass
▪LA volumes, LA Index
▪Cardiac Index
New multi-beat analysis enables analyzing a different beat and average the beats’
results for patients with atrial fibrillation

14. For cardio-oncology patients
 Advance CV imaging = Early detection of
CTRCD1
▪ Minimize anticancer therapy interruptions
▪ Improve preventive strategies for long- term
survivors
 Combination of DHM + AutoSTRAIN LV provide
fast, accurate and reproducible 3D EF and GLS
for oncology patients undergoing chemotherapy
1 Teresa López Fernández, Cardiology Department. Cardiac Imaging Lab. La Paz University Hospital. Madrid, Spain.

15. 15
3DEF & GLS
• Accurate
• Reproducible
• Automatic
• Fully validated

16. Patient with
Cardiomyopathy

17. Patient with
Cardiomyopathy

18. Patient with
Cardiomyopathy

19. 3D MV Assessment
 Mitral Valve (MV) assessment is currently
mostly qualitative
 Quantitative assessments can aide in clinical
decision-making. Doctors can define whether
the patient only needs follow-up or if patient
need an intervention to repair the mitral valve

20. Automatic Mitral Valve Quantification
with 3D Auto MV
Fully automatic quantitative analysis of
the Mitral
Valve with comprehensive set of
measurements
•Uses TOMTECs 4D MV Assessment
with
HeartModel technology to drive
automation
•Easy and comprehensive context
visualization of automatic measures
derived by accurate modelling

21. 3D Auto MV Analysis
Annlulus Leatlets Shape Cpatration Misc
- AP Diameter
- AL-PM Diameter
- Sphericity index
(AP/AL-PM)
- Intertrigonal
distance
- Commissural
Diameter
- Etc
- Anterior Leaflet
Area
- Posterior Leaflet
Area
- Posterior Leaflet
Angle
- Distal Anterior
Leaflet Angle
- Anterior Leaflet
Length
- Posterior Leaflet
Length
- Annulus Height
- Non-Planar Angle
- Tenting Volume
- Coaptation depth
- Tenting Area
- Angle AA0-AP
- Prolaps height
- Coaptation opening
Gap
- Coaptation opening
Width
- Coaptation opening
Area
- Annulus Area (2D)
- Anterior Closure
Line Length (2D )
- Anterior Closure
Line Length (3D )
- Posterior Closure
Line Length (2D)
- Posterior Closure
Line Length (3D)
- C-Shaped Annulus

22. New photorealistic rendering with
dynamic source of light
•TrueVue provides high-resolution
photo-realistic 3D rendering
•TrueVue is designed to provide better
appreciation of depth in the volume as
well as enhancing the position of
structures within the 3D volume
Live 3D TEE image Photo-realistic 3D rendering

23. • Publication
• CONVENTIONAL 3-DIMENSIONAL (3D) ECHOCARDIOGRAPHIC
RENDERING DOES NOT CONSISTENTLY provide images with
adequate detail definition and depth perception
• Transillumination (TI) is a new 3D rendering tool that uses a freely
movable virtual light to enhance image details and depth
• Enrolled 30 patients whose study results contained suboptimal
image features on conventional 3D rendering
• Scored independently by 5 cardiologists in a survey using a Likert
scale from 1 to 5
• TI appears to increase the diagnostic confidence of the readers
when it is used to enhance specific image features that are not
optimally displayed by conventional rendering, including
delineation of orifices, borders, cavities, cardiac masses and their
attachments, and structural abnormalities, p< 0.001
JACC Cardiovasc Imaging. 2019 [Epub ahead of print]

24. • Case 1 – MV Flail

25. • Case 2 – Patient with Rupture MV Chordae

26. • Case 3 Noncompaction Cardiomyopathy

27. 27