Speckle-Tracking: Vorteile, Einsatzgebiete, Limitationen

Abstract

The assessment of systolic myocardial function is one of the most important issues of transthoracic echocardiography. The ejection fraction (LVEF) has several limitations. 2 D Strain (strain derived from 2 D images) is a new tool, that allows the robust, fast and reliable measurement of longitudinal myocardial function (deformation imaging). It can help to diagnose heart failure, regional function, ischemia, differentiation of cardiomyopathies and estimate prognosis. This article focuses on the principles, advantages and limitations of this technique, as well as the clinical applications.

Kernaussagen

• Die Beurteilung der systolischen linksventrikulären Funktion ist eine zentrale Frage an die Echokardiografie. Die LVEF darf dabei aber nicht als Synonym der systolischen Funktion verstanden werden. Sie ist vor allem ein Parameter der radialen Funktion – die Aussage über die longitudinale Funktion ist gering.

• Speckle-Tracking ist die Bezeichnung für Deformationsanalysen aus dem B-Bild, die die meisten Echogeräte heute vornehmen können. Deformation bedeutet Verformung des Myokards und ist definiert als die prozentuale Verkürzung eines Segments in Bezug auf die Ausgangslänge.

• Leider gibt es keinen gemeinsamen Standard der Gerätehersteller; daher sind Speckle-Tracking-Analysen, die an unterschiedlichen Geräten durchgeführt wurden, nicht ohne Weiteres miteinander vergleichbar.

• Zu den Limitationen des Speckle-Trackings gehören z. B. schlechte Bildqualität des B-Bildes und Reverberationsartefakte.

• Einsatzmöglichkeiten des Speckle-Trackings sind z. B. die Prognoseabschätzung bei der systolischen Herzinsuffizienz, die Objektivierung regionaler Kinetikstörungen bei der Angina pectoris, der Nachweis des „apical sparing“ bei der kardialen Amyloidose, die Erkennung einer Kardiotoxizität bei Chemotherapie oder die Risikoabschätzung bei der Aortenklappenstenose.

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