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Coronary Flow Imaging
Demo Teaching – Cardiac Application
US Marketing
Coronary Arteries
Heart Segmentation
Scan Views
Example
Next arguments
Coronary Arteries
AP
AOa
VCs
VCi
Vene P
LCx
LADPDA
LCx
PDA
LCx: Left Circumflex ArteryLAD: Left Anterior DescendigPDA: Posterior Descending Artery
Right CA Left CA
Heart Segmentation: Segments in LAX and SAX
Heart Segmentation: Segments in 4Ch and 2Ch
Doppler: CFR quantification
Coronary Arteries Origin
PA
IVC
SVC
Coronary Arteries Origin
Aortic Valve
RA
RV
Papillary muscles
LR N
Chordae Tendinae (Heart
Strings)
The role of Heart Strings is to prevent
the flaps reversal into the right atrium
Doppler: CFR quantification
Images and data courtesy of Prof. Rigo
AORTA
Pulmunary
AURICOLA
Prox LAD
Mid LAD
Doppler: Quantification of Coronary Flow Reserve (CFR) for LAD (Left Anterior Descending Coronary Artery)
Ultrasound findings of coronary arteries: LAD (Prox-Mid tracts)
Normal valuesMFV=35±9 cm/s
Rigo, Cardiovascular Ultrasound 2008
Images and data courtesy of Prof. Rigo
Feasibility 78% pts
LAD I = Proximal Tract
44 cm/s
Images and data courtesy of Prof. Rigo
LAD II = Medial Tract
36 cm/s
Images and data courtesy of Prof. Rigo
Doppler: Quantification of Coronary Flow Reserve (CFR) for LAD (Left Anterior Descending Coronary Artery)
Ultrasound findings of coronary arteries: LAD (Mid-Distal tract)
Lad: mid-distal tract
Feasibility 98% ptsNormal values
MFV=25±7 cm/s
Rigo, Cardiovascular Ultrasound 2008
Images and data courtesy of Prof. Rigo
LAD III = Distal Tract
31 cm/s
Images and data courtesy of Prof. Rigo
Images and data courtesy of Prof. Rigo
Doppler: Quantification of Coronary Flow Reserve (CFR)
Images and data courtesy of Prof. Rigo
TTD NON INVASIVE
LV
94 cm/s
LAD I
LAD III
Doppler: Quantification of Coronary Flow Reserve (CFR)Example of Pathological coronary flow pattern (stenosis)
Rigo et al ESC 2010
Proximal LAD
42 cm/s
35 cm/s
Distal LAD
MID LAD
94 cm/s
Images and data courtesy of Prof. Rigo
Images and data courtesy of Prof. Rigo
Coronary Flow Reserve (CFR) is the study of coronary flow velocity during a Stress examination
Flow velocity is measured on the Left Anterior Descending Coronary Artery (LAD) within the 3 segments: (Proximal, Medial and Distal)
during Rest, Dipyridamole Stress and Recovering Phases.
Example of pathological Coronary Flow Pattern (Stenosis)The customer needs to verify the coronary flow during the REST and
after the STRESS
Doppler: CFR quantification
Images and data courtesy of Prof. Rigo
Images and data courtesy of Prof. Rigo
Reserve is performed using:
1) Phased Array probe
2) Color Doppler (for the visualization of the Coronary Artery Flow)
3) Pulsed Wave Doppler (for the Coronary Flow analysis) and Clinical Protocol of Dipyridamole Stress Echocardiography
Doppler: CFR quantification
Stress Test with CRF (Coronary Flow Reserve)
Stress Test with CRF (Coronary Flow Reserve)
Images and data courtesy of Prof. Rigo
The assessment of Coronary Blood Flow characteristics is meaningful also regarding basal cardiac activity without any
externally induced cardiac stress Typical Left Anterior Descending Coronary Artery blood flow.
Velocities at basal cardiac activity can be seen in the following image:
Doppler: CFR quantification
MyLab60/70/ClassC/Twice Preset – Cardio & CFI
Preset Cardio
Adulti - 8.08.0 CFI Cardio
Based
B-Freq TEI - Gen-M TEI - Gen-M
Angle 75°/70° 75°/70°
Gray Map 7 7
Dynamic Range 11/9 9
Compres. Dyn. 2 2
Density 1 1
Foc. 1 1
Enhance 2 2
Power 100% 100%
Persist 1/2 1/2
Sview on on
X-View 4-3-6 4-3-6
Post-ProcessingSlope 50 - Rej 20
- Sat 240Slope 50 - Rej 20
- Sat 240
Scan fast fastColorize 0/10 0/10
Range Dyn 10 10Gray Map 7 7
Compr. Din 2 2
CFM-Freq 2,3/2,5Mhz 2,8/2,5HD CFM 1 0
Filter 2 2Density 1 1
Col. Map VV13VV13 (Color Priority
- 255)Smooth Med MedPersist 3 8
PRF 3,5K/4.0hz 1.5/2Khz
Format smallPW-Freq 2.5 2.5CW-Freq 2.1 2.1
PRF6.0 (for CW about
2.0m/s)Scale about 0.60 m/s
- 1.25 m/sColorize 0 8
Sample V. 4 10Gray Map 5/6 6
Range Dyn 8 \ 5 cw PW 8/5 CWFilter 300 (600 CW) 100/150Scan Med Fast
Ris FFT Med\Max cw Med\Max cw
Thank you
Demo Teaching – Cardiac Application
US Marketing