ACUSON Origin 2D Heart Presentation

SIEMENS Healthineers SIEMENS Healthineers .. ACUSON Origin Ultrasound System 2D HeartAI 1.0 software version 1 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The purpose of this presentation is to provide an overview of the benefit and workflow of the 2D HeartAI feature on the ACUSON Origin ultrasound system. Notes No. 1 SIEMENS Healthineers Objectives SIEMENS . Healthineers ... • Review cardiac strain principles • Explain image acquisition for cardiac strain • Discuss 2D HeartAI workflow • Evaluate 2D HeartAI analysis and report 2 Unrestricted © Siemens Healthineers 2023 Speaker Notes: We will begin with a brief review of cardiac strain principles. Notes No. 2 SIEMENS Healthineers What is cardiac strain? SIEMENS. Healthineers ... • Strain is a noninvasive technique which quantifies myocardial mechanics • Strain is the change (deformation) in shape of a material (myocardium) • Tracked via speckle-tracking echocardiography (STE) 0 1 • Expressed as percentage (%) Lo Strain (€) = 𝐿1 − 𝐿0 • 𝐿0 • L0 is length at baseline • L1 is length at a given point in time 3 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Strain is defined as shortening, thickening or lengthening of the myocardium as a measure of global or regional myocardial mechanics. Speckle-tracking echocardiography (STE) enables a quantitative assessment of myocardial function with image-based analysis. The measurement of myocardial deformation is expressed as a percentage. Notes No. 3 SIEMENS Healthineers Three principles of left ventricular strain SIEMENS. Healthineers ... • Radial or Transverse (47 ± 15%)1 Global Radial Strain (GRS) • Circumferential (-23 ± 3%)1 Global Circumferential Strain (GCS) • Longitudinal (-20 ± 3%)1 Global Longitudinal Strain (GLS) radial circumferential Longitudinal Sources | 1. Yingchoncharoen, Teerapat, et al., JASE (2013) 26: 185-91 4 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The myocardium has three fundamental forms of deformation. They are radial, circumferential and longitudinal. During normal myocardial contraction, longitudinal and circumferential shortening yield negative strain. Systolic myocardial elongation in the radial plane yields positive strain. The following are normal strain values for the left ventricle: • Global Radial Strain (GRS) (47 ± 15%)1 • Global Circumferential Strain (GCS) (-23 ± 3%) 1 • Global Longitudinal Strain (GLS) (-20 ± 3%) 1 Sources | 1. Yingchoncharoen, Teerapat, et al., JASE (2013) 26: 185-91 Notes No. 4 SIEMENS Healthineers Parameters of myocardial function SIEMENS. Healthineers ... Displacement: distance that a Strain: describes myocardial certain feature, such as a deformation, or the fractional Displacement speckle, has moved between Strain change in length of a two consecutive frames (cm) myocardial segment (%) Velocity: reflects displacement Strain Rate: is the rate of per unit of time, or how fast change in strain and is Velocity the location of a feature Strain Rate expressed as 1/sec or sec-1 changes (cm/s) 5 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Four parameters used to assess myocardial function using speckle-tracking echocardiography (STE) include displacement, velocity, strain and strain rate. • Displacement: distance that a certain feature, such as a speckle, has moved between two consecutive frames (cm) • Velocity: reflects displacement per unit of time, or how fast the location of a feature changes (cm/s) • Strain: describes myocardial deformation, or the fractional change in length of a myocardial segment (%) • Strain Rate: rate of change in strain and is expressed as 1/sec or sec-1 In 2D HeartAI, the user can choose between each of the parameters for analysis. Strain is the most commonly used parameter for cardiac analysis. Notes No. 5 SIEMENS Healthineers Global longitudinal systolic strain (GLS) SIEMENS. Healthineers Clinical relevance • Studies suggest reduced strain is Prognostic value of global longitudinal strain in heart failure subjects: associated with mortality due to A recent prototype cardiovascular events Kumar Ashish a, Mohammed Faisaluddin b, Dhrubajyoti Bandyopadhyay c+, Adrija Hajra d, Eyal Herzog e Crozer-Chester Medical Center, Philadelphia, USA • GLS adds prognostic value in prediction of b Deccan College of Medical Sciences, Hyderabad, India " Mount Sinai St Luke's Roosevelt Hospital, New York, USA d IPGMER, SSKM, Kolkata, India adverse cardiovascular outcomes e Mount Sinai St Luke's Roosevelt Hospital, Icahn School of Medicine at Mount Sinai, New York, USA ARTICLE INFO and HFpEF subgroups the strain has been found to have an important prognostic value that is independent of LVEF. Nonetheless, this study in- Article history: Received 19 October 2018 cluded only patients with acute heart failure, so it is unknown whether Accepted 23 November 2018 their findings would translate to those with chronic heart failure [3]. Available online 13 December 2018 Another meta-analysis was done by Morris et al. with 2284 patients having HFpEF, and 2302 controls showed patients with HFpEF had sig- Keywords: Global longitudinal strain (GLS) nificantly lower GLS than healthy subjects [4]. Another data pool col- Heart failure (HF) lected from 16 studies (15 prospective and one retrospective) showed 1 SD change in absolute GLS was associated with decreased all-cause Sources | * . Ashish, Kumar, et al., IJC Heart & Vasculature (2019) 22: 48-49 6 Unrestricted © Siemens Healthineers 2023 Speaker Notes: A study published in the International Journal of Cardiology Heart & Vasculature in 2019 evaluated the prognostic value of global longitudinal strain in heart failure patients. To summarize, the study showed that “reduced GLS is an extraordinary predicting measure to provide a good prognosis for many heart failure related outcomes independent of ejection fraction”. The study described that GLS plays a significant role in risk stratification of chronic systolic heart failure and that GLS has greater prognostic value than ejection fraction. In conclusion, global longitudinal strain adds prognostic value in predicting cardiovascular outcomes for certain patient populations. Sources | 2. Ashish, Kumar, et al., IJC Heart & Vasculature (2019) 22: 48-49 Notes No. 6 SIEMENS Healthineers Left atrial strain SIEMENS. Healthineers ... A4C Volume • Can potentially be used as an early indicator of [ mi/m2 ] diastolic dysfunction and elevated LV filling 40 pressures* FOE • Pre-A: LA pre-systolic volume (just before the P 20 wave on ECG) – higher number can indicate AZC 10 elevated LV filling pressures 200 400 600 800 1000 The following normal LA strain values were I ms ] • Tracking Results (Summary) determined in a meta-analysis* X LA AVG GLS Cond (%) AVG GLS Res (%) 31.2 • LASr: 39% A3C AVG GLS Cont (%) -16.4 AVG ESV (ml/m2)* 25.5 • LAScd: -23% • LASct: -17% Note: Normal values are from studies performed on subjects with normal cardiac function and sinus rhythm. Sources | * . Espen Boe, Otto, et al., European Heart Journal (2022) 23;9: 1169-1170 7 S * Pathan, F., et al., J Am Soc Echocardiography (2017) 30; 1: 59-70 . Unrestricted © Siemens Healthineers 2023 Speaker Notes: Left atrial (LA) strain is currently used primarily in research settings. It can potentially be used as an early indicator of diastolic dysfunction and elevated LV filling pressures.3 The Pre-A value represents LA pre-systolic volume and occurs just before the P wave on the ECG. An increase in this value can indicate elevated LV filling pressures and diastolic dysfunction. The following normal LA strain values were determined in a meta-analysis: • LASr (reservoir): 39% • LAScd (conduit): -23% • LASct (contraction): -17% LA strain image acquisition tips include: • Ensure entire left atrium is within view and minimize dropout • Have patient perform a breath hold to reduce motion of the heart Notes No. 7 SIEMENS Healthineers Left atrial strain phases SIEMENS. Healthineers ... Left atrial strain consists of three phases* : 1. Reservoir (positive value) – left atrial filling during ventricular systole; also called the “peak” of LA strain and is measured at LAScd the end of the reservoir stage LASr 2. Conduit (negative value) – passive emptying during early ventricular diastole; measured as the difference between LASct peak reservoir and contractile strain 3. Contraction (negative value) – active emptying during late ventricular diastole; measured as the peak positive strain following the P wave (atrial contraction) QRS T P QRS 8 Sources | * . Gan, Gary C.H., et al., JAHA (2021) 10;1 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Left atrial strain consists of three phases4 : • Reservoir – left atrial filling during ventricular systole as the left atrium begins filling. The reservoir phase is also known as the “peak” of LA strain. It is measured at the end of the reservoir stage as the average of the peak systolic strain from 12 segments. • Conduit – passive emptying of the left atrium during early ventricular diastole. The conduit phase is measured as the difference between peak reservoir and contractile strain. • Contraction - active emptying of the left atrium during late ventricular diastole. The contraction phase is measured as the peak positive strain following the P wave (atrial contraction). Notes No. 8 SIEMENS Healthineers 2D HeartAI license SIEMENS. Healthineers . 2D Heart (standard configuration): two-frame analysis A4C ED CT A4C ES 66 fps only for LV, RV, LA, and RA • Results include volumes, ejection fraction, cardiac output, stroke volume, area, and fractional area change (RV) • Only ED and ES are contoured for analysis • Analysis for up to five beats Note: Strain analysis (GLS) is not included in the standard configuration. A4C Results (Beat 1 of 1) HR (bpm) 64 Bi-Plane Results LV LA RV RA LV LA EF (%) 61.5 ESV (ml) 42.6 FAC (%) 32.4 ESV (ml) 25.1 EF (%) 66.6 ESV (ml) 43.8 SV (ml) 47.1 ES Axis (cm) 4.7 EDA (cm2) 14.5 ES Axis (cm) 4.0 SV (ml) 49.7 ES Axis (cm) 4.7 EDV (ml) 76.6 ESA (cm2) 9.8 EDV (ml) 74.6 ESV (ml) 29.5 ESV (ml) 24.9 9 Unrestricted © Siemens Healthineers 2023 Speaker Notes: There are two licensing options available on the ACUSON Origin ultrasound system: The standard configuration (2D HeartAI) provides a two-frame analysis only for LV, LA, RV, and RA and does not include strain analysis or GLS. In a two-frame analysis, the algorithm automatically places and analyzes contours on the end diastolic (ED) and end systolic (ES) frames. Results include volumes, ejection fractions, cardiac output, and stroke volume, area, and fractional area change (RV). Notes No. 9 SIEMENS Healthineers 2D HeartAI+ license SIEMENS. Healthineers ... 2D HeartAI+ (full license): includes two-frame analysis A4C Segmental Strain and speckle tracking analysis • Two-frame for LV, RV, LA, and RA .10 • Speckle tracking for LV and LA to include global -20 longitudinal strain (every frame is tracked) A2C 56 Ips DE - Includes bullseye and curves -40 • o 200 400 600 800 [ ms ] LV Peak Systolic Strain [%] Tracking Results (Summary) AVG EF (%) 64.9 A4C GLS (%) 27.3 X A3C A2C GLS (%) 29.0 A3C GLS (%) 23.4 Overall GLS (%) -26.6 PSD (ms) 44.0 X NO 10 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The full license (2D HeartAI+) includes two-frame analysis and tracking analysis • Two-frame for left ventricle (LV), left atrium (LA), right ventricle (RV), and right atrium (RA) • Speckle tracking for LV and LA In a speckle tracking analysis, all frames are tracked along the cardiac cycle (only for LV and LA currently). GLS results are included with bullseye and curve analysis. Notes No. 10 SIEMENS Healthineers Objectives SIEMENS . Healthineers ... • Review cardiac strain principles • Explain image acquisition for cardiac strain • Discuss 2D HeartAI workflow • Evaluate 2D HeartAI analysis and report 11 Unrestricted © Siemens Healthineers 2023 Speaker Notes: In this section we will explain the importance of optimal image acquisition for a 2D HeartAI analysis. Notes No. 11 SIEMENS Healthineers System configuration SIEMENS. Healthineers ... Contours (Two frame - ED, ES Results) Default Curve After Speckle Tracking (LV) System Configuration Left Ventricle (A4C,A2C,A3C) LV Epicardium Segmental Strain Left Atrium (A4C,A2C) O Show O Global Strain System Settings Right Ventricle (A4C) Hide O Volume Right Atrium (A4C) O Strain Rate > Workflow Enhancement Measurement Results Default Curve After Speckle Tracking (LA) > Imaging Settings Chambers Measurements (max 6 per chamber) Global Strain > Measurement & Report Left Ventricle O Left Atrium ET EF(%) Volume › Annotations O Right Ventricle GLS(%) Default Timing/Phase After Speckle Tracking (LV) Features O Right Atrium Mass(g/m2) BSA O End Systolic Strain Peak Systolic Strain Protocols CO(U/min) Time to Peak O Post Systolic Strain Stress Echo EDV(mL/m2) BSA O Post Systolic Strain Indexed 4D Heart Nl ESV(ml/m2) BSA 2D Heart ^ SV(mL/m2) BSA Al Assist Note: Capture sends all available measurements to the report. Transducer Display measurements as BSA indexed (BSA suffix in above table) Note: Enter the Height and Weight to obtain BSA indexed values. Connectivity & Network Number of Beats (Two frame . ED, ES Results) Peripheral Devices O 2 03 04 O 5 System Management Results Format (Two frame - ED, ES Results) Individual Beat Average of Beats 12 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Default parameters can be selected from the system configuration menu. To access, System Configuration > Features > 2D HeartAI . Some options are also available during an exam from the touch screen or soft keys. Notes No. 12 SIEMENS Healthineers System configuration SIEMENS . Healthineers ... 1. Contours – select chambers to Contours (Two frame - ED, ES Results) Con Default Curve After Speckle Tracking (LV) contour; select epicardium contour for 1 Left Ventricle (A4C,A2C,A3C) LV Epicardium O Show 4 Segmental Strain Left Atrium (A4C,A2C) O Global Strain LV Right Ventricle (A4C) O Hide O Volume Right Atrium (A4C) O Strain Rate 2. Measurement Results – select Measurement Results Default Curve After Speckle Tracking (LA) Chambers measurement results for each Measurements (max 6 per chamber) O Global Strain Left Ventricle Volume chamber O Left Atrium 22 EF(%) 5 El GLS(%) Default Timing/Phase After Speckde Tracking (LV) 2 O Right Ventricle Number of Beats – select from Right Atrium O Mass(g/m2) End Systolic Strain 3. BSA O Peak Systolic Strain 6 Time to Peak options 1-5 and individual or average CO(L/min) Post Systolic Strain EDV(mU/m2) of beats BSA O Post Systolic Strain Indexed ESV(mU/m2) BSA 4. Default Curve After Speckle Tracking SV(mU/m2) BSA for LV Note: Capture sends all available measurements to the report. Display measurements as BSA indexed (BSA suffix in above table) 5. Default Curve After Speckle Tracking Note: Enter the Height and Weight to obtain BSA Indexed values. for LA Number of Beats (Two frame - ED, ES Results) 1 03 0 5 6. Default Timing/Phase After Speckle 3 O 2 Results Format (Two frame - ED, ES Results) Tracking for LV Individual Beat Average of Beats 13 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Options available in system configuration include: • Contours – select chambers to contour (LV, LA, RV, RA); select to display the epicardium contour for the LV • Measurement Results – select measurement results for each chamber; only selected options will appear in the on-screen analysis and in the report. • Number of Beats – select the number of beats to be analyzed (options 1-5) and individual beats or average of all beats • Default Curve After Speckle Tracking for LV – select default curve display for LV analysis; options include Segmental Strain, Global Strain, Volume, and Strain Rate • Default Curve After Speckle Tracking for LA – select default curve display for LA analysis; options include Global Strain, and Volume • Default Timing/Phase After Speckle Tracking for LV – select default timing/phase display for LV analysis; options include End Systolic Strain, Peak Systolic Strain, Time to Peak, Post Systolic Strain, and Post Systolic Strain Indexed. End Systolic Strain is the recommended method from the global strain task force. Notes No. 13 SIEMENS Healthineers System configuration – LV chamber options SIEMENS . Healthineers ... Measurement Results Measurements available for the left ventricle Chambers Measurements (max 6 per chamber) include: • O Left Ventricle Ejection Fraction (EF) Left Atrium MI EF (%) • Global Longitudinal Strain (GLS) Right Ventricle MI GLS (%) • Mass Right Atrium Mass (g/m2) BSA • Cardiac Output (CO) • CO (U/min) End Diastolic Volume (EDV) • End Systolic Volume (ESV) MI EDV (mL/m2) BSA • Stroke Volume (SV) MI ESV (mL/m2) BSA • End Diastolic (ED) Axis MI SV (mL/m2) • BSA End Systolic (ES) Axis Note: Capture sends all available measurements to the report. Note: The maximum of 6 per chamber Display measurements as BSA indexed (BSA suffix in above table) Note: Enter the Height and Weight to obtain BSA indexed values. corresponds to values displayed on-screen on the ED-ES layout; all measured results will populate to the report. 14 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Measurements displayed upon analysis can be selected form system configuration. A maximum of six measurements per chamber can be selected for on-screen display; when the analysis page is captured, all available measurements will go to the exam report. Measurements with BSA listed beside them can be indexed to the patient’s BSA. Patient’s height and weight must be entered on the demographics page to obtain an indexed measurement result. Measurements available for the left ventricle include: • Ejection Fraction (EF) – measurement of the percentage of blood leaving the LV with each contraction • Global Longitudinal Strain (GLS) – deformation/change in length of LV myocardium from diastole to systole • Mass – weight of the LV; can indicate LV hypertrophy • Cardiac Output (CO) – quantity (liters) of blood pumped by the heart per min • End Diastolic Volume (EDV) – volume of the LV at the peak of relaxation which is the largest volume (end diastole) • End Systolic Volume (ESV) – volume of the LV at the peak of contraction which is the smallest volume (end systole) • Stroke Volume (SV) – volume of blood pumped out of the LV with each contraction • End Diastolic (ED) Axis – length of the LV at end diastole Notes No. 14 SIEMENS Healthineers • End Systolic (ES) Axis – length of the LV at end systole Notes No. 14 SIEMENS Healthineers System configuration – LA chamber options SIEMENS . Healthineers ... Measurement Results Measurements available for the left atrium include: Chambers Measurements (max 6 per chamber) • Ejection Fraction (EF) • O Left Ventricle Global Longitudinal Strain (GLS) O Left Atrium O EF (%) • Cardiac Output (CO) O Right Ventricle GLS (%) • End Diastolic Volume (EDV) Right Atrium co (L/min) • End Systolic Volume (ESV) • [] EDV (mL/m2) Stroke Volume (SV) BSA • MI ESV (mL/m2) End Diastolic (ED) Axis BSA • End Systolic (ES) Axis [] SV (mU/m2) BSA [] ED Axis (cm) Note: Capture sends all available measurements to the report. Display measurements as BSA indexed (BSA suffix in above table) Note: Enter the Height and Weight to obtain BSA indexed values. 15 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Measurements displayed upon analysis for the left atrium can be selected form system configuration. A maximum of six measurements per chamber can be selected. When the analysis page is captured, all available measurements will go to the exam report. Measurements with BSA listed beside them can be indexed to the patient’s BSA. Patient’s height and weight must be entered on the demographics page to obtain an indexed measurement result. Measurements available for the left atrium include: • Ejection Fraction (EF) – measurement of the percentage of blood leaving the LA with each contraction • Global Longitudinal Strain (GLS) – deformation/change in length of LA myocardium from diastole to systole • Cardiac Output (CO) – quantity (liters) of blood pumped by the LA per min • End Diastolic Volume (EDV) – volume of the LA at the peak of relaxation which is the smallest volume (end diastole) • End Systolic Volume (ESV) – volume of the LA at the peak of contraction which is the largest volume (end systole) • Stroke Volume (SV) – volume of blood pumped out of the LA with each contraction • End Diastolic (ED) Major axis – length of the LA at end diastole • End Systolic (ES) Major axis – length of the LA at end diastole Notes No. 15 SIEMENS Healthineers System configuration – RV chamber options SIEMENS . Healthineers ... Measurement Results Measurements available for the left atrium include: Chambers Measurements (max 6 per chamber) • Global Longitudinal Strain Sept (GLS) Left Ventricle • [] GLS Sept (%) End Diastolic Area (EDA) O Left Atrium • End Systolic Area (ESA) O Right Ventricle BSA • Right Atrium MA EDA (cm2/m2) Fractional Area Change MI ESA (cm2/m2) BSA • End Diastolic (ED) Axis • FAC (%) End Systolic (ES) Axis [ ED Axis (cm) [] ES Axis (cm) Note: Capture sends all available measurements to the report. Display measurements as BSA indexed (BSA suffix in above table) Note: Enter the Height and Weight to obtain BSA indexed values. 16 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Measurements displayed upon analysis for the right ventricle can be selected form system configuration. A maximum of six measurements per chamber can be selected. When the analysis page is captured, all available measurements will go to the exam report. Measurements with BSA listed beside them can be indexed to the patient’s BSA. Patient’s height and weight must be entered on the demographics page to obtain an indexed measurement result. Measurements available for the right ventricle include: • GLS Sept • End Diastolic Area (EDA) • End Systolic Area (ESA) • Fractional Area Change (FAC) • End Diastolic (ED) Axis – length of the RV at end diastole • End Systolic (ES) Axis – length of the RV at end systole Notes No. 16 SIEMENS Healthineers System configuration – RA chamber options SIEMENS . Healthineers ... Measurement Results Measurements available for the left atrium include: Chambers Measurements (max 6 per chamber) • Cardiac Output (CO) Left Ventricle • [ co (L/min) End Diastolic Volume (EDV) O Left Atrium • End Systolic Volume (ESV) Right Ventricle [] EDV (mL/m2) BSA • O Right Atrium Stroke Volume (SV) MI ESV (mL/m2) BSA • End Diastolic (ED) Axis • [] SV (mL/m2) End Systolic (ES) Axis BSA DED Axis (cm) ES Axis (cm) Note: Capture sends all available measurements to the report. Display measurements as BSA indexed (BSA suffix in above table) Note: Enter the Height and Weight to obtain BSA indexed values. 17 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Measurements displayed upon analysis for the right atrium can be selected form system configuration. A maximum of six measurements per chamber can be selected. When the analysis page is captured, all available measurements will go to the exam report. Measurements with BSA listed beside them can be indexed to the patient’s BSA. Patient’s height and weight must be entered on the demographics page to obtain an indexed measurement result. Measurements available for the right atrium include: • Cardiac Output (CO) • End Diastolic Volume (EDV) • End Systolic Volume (ESV) • Stroke Volume (SV) • End Diastolic (ED) Axis • End Systolic (ES) Axis Notes No. 17 SIEMENS Healthineers Cardiac strain acquisition: physio vs. non-physio SIEMENS . Healthineers ... Acquisition with ECG (physio) Acquisition without ECG (non-physio) • Use a beat capture – must have at least one full • Use a time capture R-R capture • Only one beat can be analyzed • Acquire one extra beat or extended R-R • Speckle tracking is still available for LV and acquisition LA • Ensure ECG tracing is optimized and clear • ED/ES frames are detected as largest and • Multiple heart cycles can be analyzed and smallest chamber sizes averaged (up to five) 18 Unrestricted © Siemens Healthineers 2023 Speaker Notes: There are two methods of acquisition for 2D HeartAI analysis: 1. Acquisition with an ECG (physio) • Set capture to beats; this can be configured as the default but can also be changed from the soft keys during an exam • At least one full R-R must be captured to analyze the minimum of one beat; the user can either acquire one extra beat or acquire with an extended R-R capture • Up to five heart cycles can be analyzed and averaged 2. Acquisition without an ECG • Set capture to time (seconds); this can be done from the soft keys during an exam • Only one beat can be analyzed without an ECG • Speckle tracking is still available for the LV and LA without an ECG • The algorithm will automatically detect the view; ED and ES frames are detected as the largest and smallest chamber sizes Notes No. 18 SIEMENS Healthineers Cardiac strain acquisition: image optimization SIEMENS .. ; Healthineers ... 40 – 80 frames per second (fps) is recommended for optimal speckle tracking results* • (an elevated heart rate will require a higher frame rate) • First, increase Line Density; next reduce depth; then reduce field of view when needed for increased frame rates • Acquire steady beats, without any changes to field of view or depth – have patient hold breath if needed • Obtain elongated (non-foreshortened) views of the LV 19 Sources | * . Mor-Avi, Victor, et al., European Journal of Echocardiography (2011) 12;3: 167-205 Unrestricted © Siemens Healthineers 2023 Speaker Notes: In this slide, we review the optimal frame rate range. High frame rates do not necessarily improve tracking performance. Increasing the frame past the maximum limits can cause a decrease in tracking performance. Lower frames will not limit the ability to perform a cardiac strain analysis, but the performance of the analysis may be reduced because the algorithm cannot follow the motion of the speckles and errors in displacement estimation can occur. Note: Frame rate is dependent on the patient’s heart rate. Higher heart rates should have higher frame rates. Notes No. 19 SIEMENS Healthineers Cardiac strain acquisition: image optimization SIEMENS. Healthineers' ... Challenges in LA strain • LA is in the far field of the image • Pulmonary veins and left atrial appendage orifices interrupt LA contouring (If approximately one-third of the atrial contour contains drop-outs, the analysis should be rejected)* • Thin walls, compared to LV Tips for LA strain acquisition • Ensure frame rate is adequate – increase line density, then decrease field of view • Have patient perform a breath hold to decrease motion of the heart • Avoid foreshortened images of the LA – the long axis of the LA is slightly different than the long axis of the LV 20 Sources | * . Badano, et al., European Heart Journal (2018) 19; 591-600 Unrestricted © Siemens Healthineers 2023 Speaker Notes: In this slide, we review the optimal frame rate range. High frame rates do not necessarily improve tracking performance. Increasing the frame past the maximum limits can cause a decrease in tracking performance. Lower frames will not limit the ability to perform a cardiac strain analysis, but the performance of the analysis may be reduced because the algorithm cannot follow the motion of the speckles and errors in displacement estimation can occur. Note: Frame rate is dependent on the patient’s heart rate. Higher heart rates should have higher frame rates. Notes No. 20 SIEMENS Healthineers Objectives SIEMENS . Healthineers ... • Review cardiac strain principles • Explain image acquisition for cardiac strain • Discuss 2D HeartAI workflow • Evaluate 2D HeartAI analysis and report 21 Unrestricted © Siemens Healthineers 2023 Speaker Notes: In this portion of the presentation, we will review the 2D HeartAI technology workflow on the ACUSON Origin Ultrasound System. Notes No. 21 SIEMENS Healthineers 2D HeartAI workflow overview SIEMENS ... Healthineers ... 1. Launch software from live imaging (Cine) or Review A4C Segmental Strain • From Cine – two frame analysis (LV, LA, RV, RA) • From Review – tracking results for GLS (LV, LA) 10 × -20 > 2. Automated view detection will place contours and A2C OE- analyze -40 200 400 600 800 1000 LV Peak Systolic Strain [%] Tracking Results (Summary) LV 3. Analysis with contours and measurement results Anterior AVG EF (%) 58.4 X A4C GLS (%) -19.0 A3C A2C GLS (%) 28.3 ABC GLS (%) 16.0 -12% Overal GLS (%) 21.1 PSD (ms) 55.5 X 22 Unrestricted © Siemens Healthineers 2023 Speaker Notes: 1. Launch software from live imaging or Review 2. Automated view detection will place contours and analyze 3. Analysis with contours and measurement results Notes No. 22 SIEMENS Healthineers ED-ES View: two-frame (Edit) layout SIEMENS. Healthineers ... Display at launch for Cine workflow or when a single A4C ED A4C ES 66 fps clip/view has been selected for analysis • Displays contours and results for configured chambers • Select individual beat to analyze, or select multiple beats • Only layout in which edits can be made to contours • Edits can only be performed on the ED and ES frames A4C Results (Beat 1 of 1) MAC HR (bpm) 64 Bi-Plane Results LV LA RV RA LV LA EF (%) 61.5 GLS (%) 25.2 GLS FW (%) -20.3 GLS (%) 42.2 EF (%) 66.6 GLS (%) GLS (%) -25.2 ESV (ml) 42.6 FAC (%) 32.4 ESV (ml) 25.1 GLS (%) -27.1 ESV (ml) 43.8 SV (ml) 47.1 ES Axis (cm) 4.7 EDA (cm2) 14.5 ES Axis (cm) 4.0 SV (ml) 49.7 ES Axis (cm) EDV (ml) 76.6 ESA (cm2) 9.8 EDV (ml) 74.6 ESV (ml) 29.5 ESV (ml) 24.9 23 Unrestricted © Siemens Healthineers 2023 Speaker Notes: When 2D HeartAI is launched from Cine or when a single clip / view has been selected for analysis, the ED-ES View is the default layout that appears. The ED-ES View displays contours and results for configured chambers and is the layout in which edits can be made to the contours. Additionally, edits can only be performed on the ED and ES frames. The user can select individual beats to analyze or select multiple beats. Notes No. 23 SIEMENS Healthineers Launching 2D HeartAI from Cine SIEMENS .. : Healthineers' ... • Enables user to select a view during live imaging 5Z1 for analysis Cardiac TIS:0.34 MI:0.88 52fps 95% • Only one view at a time can be analyzed 2D H Mid 3dB/DR61 • Includes two frame analysis only (no bullseye or curve analysis) • All four chambers are analyzed (LV, LA, RV, RA) Note: Right heart analysis is only performed on a four chamber image in Cine or Review and does not include speckle-tracking results. 55bpm Lead Ill 24 Unrestricted © Siemens Healthineers 2023 Speaker Notes: • Launching 2D HeartAI from Cine (live imaging) enables the user to select the currently obtained image for analysis. • Only the current view can be analyzed in Cine. • Cine analysis includes two frame results (no bullseye or curve analysis) • All four chambers are analyzed in Cine (LV, LA, RV, RA) Note: Right heart analysis is only performed on an apical four chamber image from Cine or Review and does not include tracking results. Notes No. 24 SIEMENS Healthineers Launching 2D HeartAI from Cine SIEMENS .. : Healthineers' ... AMCED AMC ES 66 1ps Launding 20 Heeg unthing 20 1mart MAG Results (Beat 1 of 1) KB (bem) 64 8-Mane Results LA RA LV LA G1.5 GLS(%) 252 GSFW(%) -203 GL5(%) 42.2 EF (%) 66.6 GLS1%) 25.7 GLS (%) -252 ESV (mi) 420 FACCE3 324 ESY (mb) 251 G.50%) -271 ESVOR0) 439 Cancel 47.1 ES Avis (cm) IDA (cm") 145 [5 Avis (cm) 4.0 SV [ml) EDY (m) 765 ESA (cm?) EDV (m 746 ESY(mb) 295 ESY (ml) 249 Freeze image and select 2D Enter Review HeartAI from the touch Contours are detected Two frame analysis of all four chambers screen 25 Unrestricted © Siemens Healthineers 2023 Speaker Notes: To launch 2D HeartAI from Cine: 1. Obtain the desired view (apical four chamber is suggested) 2. Select 2D HeartAI from the touch screen 3. Contours are detected 4. Two frame analysis of all four chambers is displayed in the ED-ES display – contours can be edited from this screen and results will update Notes No. 25 SIEMENS Healthineers Launching 2D HeartAI from Cine SIEMENS. Healthineers' ... There are two suggested ways to effectively use Cine A4C ED A4C ES 66 fps workflow: 1. Analysis for right heart only – once results for all chambers appear, remove LV/LA from the touch screen. The user can then complete GLS for left heart from Review using all three apical views. ------ 2. Two frame analysis for all four chambers – results for all chambers are two frame results. The user will still need to complete the LV/LA from Review A4C Results (Beat 1 of 1) HR (bpm) 64 Bi-Plane Results ... for tracked GLS results. LV LA RV RA LV LA EF (%) 61.5 GLS (%) 25.2 GLS FW (%) -20.3 GLS (%) 42.2 EF (%) 66.6 GLS (%) GLS (%) -25.2 ESV (ml) 42.6 FAC (%) 324 ESV (ml) 25.1 GLS (%) 27.1 ESV (ml) 43.8 SV (ml) 47.1 ES Axis (cm) EDA (cm2) 14.5 ES Axis (cm) 4.0 SV (ml) 49.7 ES Axis (cm) EDV (ml) 76.6 ESA (cm2) 9.8 EDV (ml) 74.6 Note: Two-frame GLS values will only be ESV (ml) 29.5 ESV (ml) 24.9 available with the advanced license. 26 Unrestricted © Siemens Healthineers 2023 Speaker Notes: There are two different ways that Cine can be effectively used: 1. Analysis for right heart only – once results for all chambers appear, remove LV/LA from the touch screen. The user can then complete GLS for left heart from Review using all three apical views. 2. Analysis for all four chambers – results for all chambers are two frame results. The user will still need to complete the LV/LA from Review for tracked GLS results. Notes No. 26 SIEMENS Healthineers Launching 2D HeartAI from Review SIEMENS .. : Healthineers ... A4C Segmental Strain • Enables users to select captured data to analyze cardiac chambers – includes GLS (bullseye and curve results) for LV and LA -101 • Two ways to launch: -20 AZC 1. Group selection – select apical 4, 3, and 2 -30 chamber views as a group in Review O 200 400 600 1000 [ ms ] 2. Individual selection – select apical 4, 3, and 2 LV Peak Systolic Strain [%] Tracking Results (Summary) X chamber views one at a time Anterio LY AVG EF (%) 59.6 A4C GLS (%) 23.1 V 53 bpm AZC GLS (%) -19.6 56 tps A3C GLS (%) -19.5 Overall GLS (%) -20.7 PSD (ms) 787 Inferior -20 27 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Launching 2D HeartAI from Review enables the user to select previously captured data to analyze cardiac chambers. This includes GLS results for the left ventricle and left atrium. There are two ways to launch 2D HeartAI from Review: 1. Group Selection – select apical 4, 2, and 3 chamber views from Review and analyzed all three at once. 2. Individual selection – select apical 4, 2, and 3 chamber views individually from Review and analyze one at a time Notes No. 27 SIEMENS Healthineers Review workflow: individual view selection SIEMENS .. : Healthineers' ... Use to analyze one clip / view at a time 54 bpm Tracking Results (A4C) 52 fps LV • A single view selected from Review and GLS (%) 24% 627 20 EF (%) CO (imin) analyzed EDV (mli")* ESV (ml/m2)" • Views can be selected in any order -16% -16% Bi-Plane Results • Bullseye View – displays bullseye results EF (%) ao (imin) EDV (mlen']* Single View – displays tracking results only ESV (miin2)* • for selected view Segmental Strain 200 600 1000 ( ms ) Why would individual selection be used over group selection? • User can’t obtain all three apical views • User only wants to analyze apical four chamber 28 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Individual view selection workflow is used to analyze one clip or view at a time. A single view is selected from Review and analyzed. Views can be selected in any order. • ED-ES View is the only view in which the user can edit contours • Bullseye View – displays bullseye results once all three views are completed • Single View – displays tracking results only for selected view Notes No. 28 SIEMENS Healthineers Review workflow: individual view selection SIEMENS. Healthineers' ... 1. Select desired apical 4, 2, or 3 camber view 29 [1] 2. Select 2D HeartAI 3. ED-ES View will display; user can edit from this screen only 4. Select Bullseye View or Single View for analysis (once all three views are analyzed, bullseye will be completed) -100% F 9 -100%.Fr 107 Note: If any non B-mode images are selected, 2D HeartAI will not be available on the touch screen. 1100% Fres 29 Unrestricted © Siemens Healthineers 2023 Speaker Notes: To analyze a single view at a time: 1. Select the desired view (apical 4, 2 or 3 chamber) 2. Select 2D HeartAI from the touch screen 3. ED-ES View will display, allowing the user to edit if needed 4. Select Bullseye View or Single View for analysis (once all three views are analyzed, the completed bullseye will be displayed) Notes No. 29 SIEMENS Healthineers Review workflow: group selection SIEMENS . Healthineers ... Use to analyze more than one clip / view at a time Review 1. Press Select Multiple Patient 1 Review 2. Select apical 4, 2, and 3 chamber views Imaging ingle Select Multiple Select Compare 3. Select 2D HeartAI Review Report Select All elect None End Exam Flag Delete Image(s) Protocol Text Sort By Off Time TIP: Once all views are chosen, select Compare to Copy to Film review selected images prior to launching 2D 3 HeartAI to ensure all three apical views are included. 2D. Heart Left Margin Right Margin Sync Mode Playback Page None Cine 10 of 11 NOTE: If more than three clips are selected (or irrelevant clips are selected), the 2D HeartAI option on the touchscreen will be unavailable, and analysis will not launch. 30 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Group selection is used to analyze more than one clip or view at a time. This is the best workflow to use to obtain a GLS analysis with all three apical views. 1. Press Select Multiple 2. Select the apical 4, 2, and 3 chamber views for analysis 3. Select 2D HeartAI 4. The bullseye view will be the default analysis layout; the user can select an individual view to edit or view analysis Notes No. 30 SIEMENS Healthineers Review workflow: group selection SIEMENS ... Healthineers ... • Bullseye View is the default analysis layout A4C Segmental Strain when more that one apical view is selected % -10 • Select the Single View icon within a viewport to view an individual apical 4, 2, or AZC -20 3 chamber image OE 200 400 600 800 1000 [ ms ] Select the Edit icon in Single View to edit LV Peak Systolic Strain [%] Tracking Results (Summary) • X Anteri LV current view 20 AVG EF (%) 59.6 A4C GLS (%) AZC GLS (%) 23.1 V 55 bpm -19.6 56 1ps ABC GLS (%) -195 Select the Bullseye icon to return to the Overall GLS (%) -20.7 • Lateral PSD (ms) 787 Bullseye layout Select Hide Segment Values to remove the Inferior • segment values from the viewport images 31 Unrestricted © Siemens Healthineers 2023 Speaker Notes: • Bullseye View is the default analysis layout when analyzing more than one apical image • Select the Single View icon within a viewport to view an individual apical 4, 2, or 3 chamber image • Select the Edit icon in Single View to edit the current view • Select the Bullseye icon to return to the Bullseye layout • Select Hide Segment Values to remove the segment values from the viewport images Notes No. 31 SIEMENS Healthineers Review workflow: view detection and contours SIEMENS .: Healthineers' ... A4C ED A4C ES 66 tps Review 2D Heart Exit Hide Contours Rename View ED-ES Assist RV LV Exclude Beat Beats Analyzed 2 Tuning / Pluse Curve RA LA Delete Contour Add Contour ESS MC Results (Beat 1 of 1) HR (bpm) 64 Bi-Plane Results GLS LV LV EF (%) Overall GLS (%) Single View ED-ES View LV Epi GLS (%) -25.2 GLS (%) -27.1 Bullseye View A4C GLS (%) -252 Undo Average Result 46.9 76.4 SV (ml) A2C GLS (%) -29.0 EDV (ml) .............................................. ESV (m) EDV (ml) A3C GLS (%) -26.8 ESV (ml) ED ES Cine Grx Beats Enter Review ED-ES View: only page where ED and ES timing can be edits can be made to contours changed from the soft keys 32 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Views and contours are automatically detected by the software’s algorithm. Once detected, the ED-ES View will display the end diastolic and end systolic frames with contours in place. This is the only page in which edits can be made to the contours. Additionally, the ED and ES frames can be adjusted from the ED-ES View. Notes No. 32 SIEMENS Healthineers Editing contours SIEMENS. Healthineers ... ED-ES View A4C ED A4C ES 66 fp Contours can be edited by entering ED-ES View from the touch screen • Cursor becomes available when user clicks on the ED or ES image to activate the viewport – edits can only be made in ED-ES View on the displayed ED or ES frame A4C Results (Beat 1 of 1) bpm) 64 Bi-Plane Re GLS Active region of contour becomes highlighted LV LV LV • EF (%) 61.4 EF (%) 67.2 Overall GLS (%) -27.0 GLS (%) -25.2 GLS (%) -27.1 A4C GLS (%) • When pointer is closer to contour, a smaller SV (ml) 46.9 SV (ml) 50.0 A2C GLS (%) 29.0 region becomes active EDV (ml) 76.4 EDV (ml) 74.5 A3C GLS (%) -26.8 ESV (ml) 29.5 24.5 • When pointer is further from contour, a larger region becomes active 33 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The user can edit the automated contours from the ED-ES View. Edits can only be made on an ED or ES frame. • When performing 2D HeartAI on an apical four chamber image or from Cine, the ED-ES View is the default display on the monitor. • When performing a complete GLS analysis, the Bullseye page is the default display, and the user must select the Edit function on a single view to edit contours. To edit contours: 1. Select the ED or ES frame with the cursor to activate 2. The active region of the contour becomes highlighted 1. When the pointer is closer to the contour, a smaller region becomes active 2. When the pointer is further from the contour, a larger region becomes active Notes No. 33 SIEMENS Healthineers Touch screen – ED-ES View SIEMENS. Healthineers ... • Hide Contours – select to hide Review contours across both views Rename View – Rename analyzed view 2D Heart Al • (or undetected view) Exit • Chamber Selection – select to enable or disable a chamber Hide Contours Rename View A4C ED-ES Assist • Undo – reverts up to 10 edits Beats Analyzed performed by the user RV LV Exclude Beat 2 Timing / Phase RA Delete Contour Add Contour ESS Segment Note: when a user chooses a new view, the stored edits will start over for the Undo Single View Bullseye View ED-ES View Undo LV Epi Average Result function. ED ES Cine love -+ Get -Go To-) Fry Beats 34 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The following options are available on the touch screen when in ED-ES View: 1. Hide Contours – select to hide contours across both views; select a second time to bring the contours back 2. Rename View – select to rename analyzed view (or undetected view) 3. Chamber Selection – select to enable or disable a chamber (results are removed from the analysis and report) 4. Undo – reverts up to the previous 10 edits performed by the user (when a user chooses a new view, the stored edits will start over for the Undo function) Notes No. 34 SIEMENS Healthineers Touch screen – ED-ES View SIEMENS . Healthineers ... • ED-ES Assist – chooses frames that may Review be better than the ones selected based off the ECG 2D Heart Al • Exclude Beat – excludes contours of Exit selected beat; also excludes the beat from averaged results Hide Contours Rename View ED-ES Assist A4C • Beats Analyzed – changes number of beats analyzed (choose from 1-5) RV LV Exclude Beat Beats Analyzed 2 • Delete Contour – select to delete and Timing / Phase RA Delete Contour Add Contour redraw a contour ESS Segment Single View Bullseye View ED-ES View Undo LV Epi Average Result ED Cine love -+ Get -Go To-) ES Frs Beats 35 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The following options are available on the touch screen when in ED-ES View: 5. ED-ES Assist – triggers the ED-ES Assist algorithm and chooses frames that may be better than the ones selected based off the ECG (ED-ES Assist analyzes 3 seconds of data and will perform 1-2 beats) 6. Exclude Beat – excludes contours of the currently selected beat; also excludes the beat from results when averaged 7. Beats Analyzed – changes the number of beats analyzed; choose from 1 to 5 beats 8. Delete Contour – select to delete the currently active contour and redraw a new contour Notes No. 35 SIEMENS Healthineers Touch screen – ED-ES View SIEMENS . Healthineers ... • Add Contour – select to add missing Review contour on a key frame 2D Heart Al • LV Epi – enables or disables the LV epicardium and associated result (LV Exit mass) • Average Result – select to average Hide Contours Rename View ED-ES Assist A4C results for more than one beat RV LV Exclude Beat Beats Analyzed 2 Note: The user must add contours for both Timing / Phase RA Delete Contour Add Contour the ED and ES views to obtain results ESS Segment Single View Bullseye View ED-ES View Undo LV Epi Average Result ED ES Cine love -+ Get -Go To-) Frs Beats 36 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The following options are available on the touch screen when in ED-ES View: 9. Add Contour – select to add a missing contour on a key frame; a missing contour could be due to algorithm or detection failure 10. LV Epi – enables or disables the LV epicardium and the LV mass result associated with it 11. Average Result – select to average the results if more than one beat is analyzed Note: The user must add contours for both the ED and ES frames to obtain results. Notes No. 36 SIEMENS Healthineers Soft keys – ED-ES View SIEMENS. Healthineers ... • Move / Set ED – use to alter ED Review frame (rotate to Move, press to Set) 2D Heart Al • Move / Set ES – use to alter ES frame (rotate to Move, press to Set) Exit • Cine (Frs / Beats) – physio navigation by beats or frames Hide Contours Rename View A4C ED-ES Assist (defaulted to beat) Beats Analyzed • LV Epi Offset – adjust offset RV LV Exclude Beat 2 (thickness) of LV Epi contour; Timing / Phase RA Delete Contour Add Contour available on apical 4 and 2 chamber ESS Segment views for the LV Single View Bullseye View ED-ES View Undo LV Epi Average Result ED ES Cine LV Epi Offset Frs Beats 37 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Soft key options that are available from the ED-ES View include: 1. Move / Set ES – use to change the ED frame (rotate to Move, press to Set) 2. Move / Set ES – use to change the ES frame (rotate to Move, press to Set) 3. Cine (Frs / Beats) – physio navigation by beats or frames (defaulted to beat); use beats with ECG capture, use seconds with non-ECG capture. 4. LV Epi Offset – adjusts the offset (thickness) of the LV epicardium contour to the endocardium contour (available on apical 4 and 2 chamber views) Notes No. 37 SIEMENS Healthineers Changing ED and ES Frames SIEMENS. Healthineers' ... • ED and ES frames are labeled as purple markers A4C ED A4C ES 66 fps on the ECG tracing as well as labels on viewports • Move and set ED or ES frames with softkeys • Rotate soft key to move – active frame on ECG tracing will have a yellow marker when moving; when inactive, will return to gray • Press soft key to set – new ED or ES frame will be set (purple marker will move) • New contours will populate, results will update A4C Results (Beat 1 of 1) HR (bpm) 64 Bi-Plane Results GLS LV LV LV EF (%) EF (%) 66.0 Overall GLS (%) -26.9 GLS (%) -24.8 GLS (%) -26.9 A4C GLS (%) -24.8 SV (ml) 44.8 SV (ml) 48.6 A2C GLS (%) 29.0 ED ES EDV (ml) 74.6 EDV (ml) 73.6 A3C GLS (%) -26.3 ESV (ml) 29.8 ESV (ml) 25.0 + Move + Set + Go To + 38 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The ED and ES frames are labeled as purple markers on the ECG tracing as well as labeled on viewports. The ED and ES frames can be edited from the ED-ES View page. Adjust ED and ES frames from the softkeys labeled ED and ES. • Rotate the soft key to move the ED or ES marker – the active frame on the ECG tracing will have a yellow marker when moving; when inactive, it will return to gray • Press the soft key to set a new ED or ES frame • Once the ED or ES frame is changed, new contours will populate automatically on that newly set frame and results will update Notes No. 38 SIEMENS Healthineers Deleting a contour SIEMENS . Healthineers ... • Delete Contour removes contours of the selected chamber from the ED or ES frame within the active viewport; also removes the LA LV RA RV analysis from the results table and the report (Available for chambers that are enabled / detected) Delete Contour • Available for chambers which are enabled (can be changed from the touch screen) • After deletion, a manual contour becomes available for the deleted chamber; the user will be prompted to place contour points or can cancel placement of a new contour 39 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Select Delete Contour to remove the currently displayed contours of the selected chamber from the ED or ES frame within the active viewport. Deleting a contour will also remove the analysis from the results table. This option is available for chambers that are enabled and / or detected. Delete Contour is available for chambers which are enabled; this can be changed from the touch screen options. After deletion, a manual contour becomes available for the deleted chamber; the user will be prompted to place contour points or can cancel placement of a new contour. Notes No. 39 SIEMENS Healthineers Adding a contour SIEMENS. Healthineers' ... • Add Contour places a new contour on the selected chamber from the ED or ES frame ABC ED A3C. ES 45 fp within the active viewport with manual placement of contour points • Only available when viewport is on ED or ES frame • Will only be available for the active viewport • Select inside of the ED or ES frame or use the trackball to alternate between the two • For each cardiac view, a guide is in the bottom left-hand corner of the monitor for A3C Results ( Beat 1 of 1 ) HR (bpm) 56 the order in which to place the three points LV Place Post. AntSept. Apex points to draw LV contour Delete Contour Add Contour 40 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Select Add Contour to place a new contour on the selected chamber from the ED or ES frame within the active viewport. Manual contour points will become available with prompts to instruct the user on the order in which to place the points. Add Contour is only available when one of the viewports is on an ED or ES frame. When selected, contour will only be available for the currently active viewport. Notes No. 40 SIEMENS Healthineers Multiple beats analysis SIEMENS. Healthineers' ... • 1 – 5 beats can be analyzed, depending on how A4C ED A4C ES 66 fps many beats are available • Increasing beats analyzed will move the ECG margin to the left to include prior beats • Viewports will display current beat that is being analyzed A4C Results (Heat 1 of 1) HR(bpm) 64 Hi-Hane Results Rotate the Cine soft key to scroll to different LA RA • EF (%) 61.5 GLS (%) 25.2 GLS FW (%) -20.3 GLS (%) 42.2 EF (%) 66.6 GLS (%) beat(s) GL5 (%)) -25.2 ESV (m) 426 FAC (%) 324 ESV (ml) 251 GLS (%) -27.1 ESV (mi) 438 SV (ml) 47.1 ES /ods (cm) 4.7 EDA (cm2) 14.5 ES Axis (cm) 4.D SV [m0) 49.7 ES /ods (cm) EDV (mb) 76.6 ESA (cm") EDV (ml) 74.6 ESV (ml) 29.5 ESV (ml) 24 9 3 5 RV Beats Analyzed 1 41 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Multiples beats can be analyzed when an ECG is used to capture data. The user can select up to five beats for analysis as long as at least five beats are acquired. If more than one beat is analyzed, beats can be averaged. Increasing the number of beats analyzed will move the margin to the left. The viewports will display the beat that is currently being analyzed. To scroll to and view a different beat, rotate the Cine soft key. Notes No. 41 SIEMENS Healthineers Non-physio workflow SIEMENS. Healthineers ... Ability to perform analysis in cine and review workflows on non-physio data (no ECG) • Launch the same way as with physio • ED and ES frames are determined by largest and smallest LV size • Editing can still be performed from ED-ES View -1009 chr.26 • Only one beat can be analyzed without physio 47 COM 48 [[I] .100% From -- 1009 acht Pointer 42 Unrestricted © Siemens Healthineers 2023 Speaker Notes: 2D HeartAI can also be performed on images that are acquired without an ECG (non- physio). The non-physio workflow is the same as the physio workflow – select image(s) to analyze and enter the 2D HeartAI software. The software’s algorithm will determine ED and ES by detecting the largest and smallest LV size. Once analysis is complete, the Bullseye View will display. The user can still return to the ED-ES View to edit if needed. Note that only one beat can be analyzed with a non-physio workflow Notes No. 42 SIEMENS Healthineers 2D HeartAI with contrast SIEMENS ... Healthineers' ... Segmental Strain • Fully automated tracking analysis is available A4C 34 lp for the left ventricle – view classification and 101 contour placement -10- 20 • Includes GLS and bullseye results AZC -30 40 • The ACUSON Origin ultrasound system is the 200 400 600 800 [ ms ] only cardiac ultrasound system in its class to LV Peak Systolic Strain [%] Tracking Results (Summary) have this feature! X Anteric LV AVG EF (%) A4C GLS (%) 24.5 A3C A2C GLS (%) 26.6 A3C GLS (%) -21.9 Overall GLS (%) 24.3 PSD (ms) 48.1 Inferior 20 43 Unrestricted © Siemens Healthineers 2023 Speaker Notes: 2D HeartAI is available on contrast images of the left ventricle and includes fully automated view classification and contour placement for tracking analysis. • Includes GLS and bullseye results The ACUSON Origin ultrasound system is the only cardiac ultrasound system in its class to have this feature! Notes No. 43 SIEMENS Healthineers Objectives SIEMENS . Healthineers ... • Review cardiac strain principles • Explain image acquisition for cardiac strain • Discuss 2D HeartAI workflow • Evaluate 2D HeartAI analysis and report 44 Unrestricted © Siemens Healthineers 2023 Speaker Notes: In this portion of the presentation, we will evaluate 2D HeartAI strain analysis and report. Notes No. 44 SIEMENS Healthineers Tracking analysis – Bullseye View SIEMENS .. : Healthineers ... Bullseye View displays a summary page with A4C Segmental Strain 2 bullseye and curve display for all segments (GLS) 1. Viewports – display of each view analyzed 10 × 2. Curves – LV curve display (choose value from -20 > touch screen) A2C OE- 3. Bullseye – completed bullseye with segment -40 200 400 600 800 1000 values (choose value from touch screen) 1 LV Peak Systolic Strain [%] Tracking Results (Summary) 4. Summary – list of LV chamber results from Anterior LV AVG EF (%) X analysis A4C GLS (%) -19.0 A3C A2C GLS (%) -28.3 ABC GLS (%) -16.0 217% Overal GLS (%) -21.1 TIP: Press the Update key on the control panel to 55.5 19% PSD (ms) change the currently selected viewport. 11 3 4 MX N 45 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Bullseye View displays a summary page with bullseye and curve display for all segments (GLS). Components of the Single View layout include: 1. Viewports – includes display of all three views analyzed and includes segment values 2. Curves – changes value of curve display (change the value of displayed results from the touch screen) 3. Bullseye – completed bullseye with segment values (change the value of displayed results from the touch screen) 4. Summary – list of averaged chamber (apical 4, 3 and 2) results from analysis Notes No. 45 SIEMENS Healthineers Tracking analysis – Bullseye View SIEMENS ... Healthineers' ... • Hovering the cursor over a segment on the bullseye highlights the associated curve and -10 segment within the viewport(s) • Hovering the cursor over a curve will display the X and Y values ACQ.5(%) AZCCL3 (S) APCCAS (S) Overal CLS 4%I • Remove a segment by selecting from the bullseye Heart rate variation message when the 1000 • variation is greater than 10% HR Variation > 10% : A4C = 61 bpm, A2C = 61 bpm, A3C = 45 bpm Note: Removing a segment from the bullseye does not change GLS values. 46 Unrestricted © Siemens Healthineers 2023 Speaker Notes: • Hovering the cursor over a segment on the bullseye will highlight the associated curve as well as the segment within the viewport(s) • Hovering the cursor over a curve will display the X and Y values from the graph • A segment can be removed by selecting it on the bullseye – removing a segment from the bullseye does not change the GLS value • A heartrate variation message will appear if the heart rate varies greater than 10% between the three apical views; the message will list out the heart rate for each view Notes No. 46 SIEMENS Healthineers Bullseye View touch screen SIEMENS . Healthineers ... The Bullseye View touch screen includes the Review following options: 2D Heart Timing / Phase – changes timing / phase Exit • parameters displayed Hide Contours • Curve – changes Curve parameters displayed • Hide Contours – removes contour display from LV Beats Analyzed all views Chamber selection – select currently displayed Timing / Phase Curve • PSS Segmen RA LA chamber results Bullseye View • Exit – select to come out of 2D HeartAI and back Single View ED ES View to active imaging AVC Cine • AVC – rotate to adjust aortic valve closure time; press to set Cine – rotate to cine through frames Rotate to adjust Rotate to Cine • aortic valve through closure frames 47 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Options available on the Bullseye View touch screen include: • Timing / Phase – changes the currently displayed timing / phase parameters; options include Peak Systolic Strain, End Systolic Strain, Time to Peak, Post Systolic Strain, and Post Systolic Indexed (the default parameter can be selected in system configuration) • Curve – changes the currently displayed Curve parameters; options include Segmental Strain, Strain Rate, Volume, and Global Strain (the default parameter can be selected in system configuration) • Hide Contours – removes contour display from all views • Chamber Selection – select currently displayed chamber results • Exit – takes the user out of 2D HeartAI and back to active imaging Soft keys include: • AVC (aortic valve closure) – changes the timing of the aortic valve closure; rotate soft key to adjust timing, press to set and change the timing. Adjusting the AVC will change the GLS results • Cine – rotate to scroll through frames of currently selected acquired image Notes No. 47 SIEMENS Healthineers Timing / Phase options SIEMENS. Healthineers' ... Timing / Phase options available for the bullseye summary include: Peak Systolic Spain End Systolic Strain Time to Peak Post Systolic Strain Post Systolic Indexed • Peak Systolic Strain – peak strain value during Timing / Phase Curve systole, measured before aortic valve closure ESS Global Stmin (AVC) • End Systolic Strain – strain value at end systole, measured at AVC • Time to Peak – time it takes to reach peak strain Post Systolic Strain – strain value after end Note: End Systolic Strain is the parameter • system, measured after AVC recommended by the EACVI / ASE / Industry Task Force for routine exams.* • Post Systolic Indexed – ratio between deformation (strain) after end systole divided by total deformation 48 Sources | * . Voigt, et al., JASE (2015) 28;2: 183-193 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Timing / Phase options available for the bullseye summary include: • Peak Systolic Strain – the peak strain value during systole, measured before aortic valve closure (AVC) • End Systolic Strain – strain value at end systole, measure at AVC; this is the parameter that is recommended for reporting by the EACVI / ASE / Industry Task Force for routine exams • Time to Peak – amount of time it takes to reach the peak strain value • Post Systolic Strain – strain value after end systole, measured after AVC • Post Systolic Indexed – ration between deformation (strain) after end systole divided by total deformation Notes No. 48 SIEMENS Healthineers Curve options SIEMENS ... Healthineers' ... Curve options available for the bullseye summary are: • Segmental Strain – average value in each segment of the cardiac chamber • Strain Rate – rate of deformation (how fast Segmental Strain Strain Rate Volume Global Strain the deformation occurs) • Volume – change in chamber volume from ED Curve to ES Global Strain • Global Strain – strain calculated by using the entire myocardial line length to calculate deformation; can also be computed by averaging the values from the segments 49 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Curve options available for the bullseye summary are: • Segmental Strain – average value in each segment of the cardiac chamber • Strain Rate – rate of deformation (how fast the deformation occurs) • Volume – change in chamber volume from ED to ES • Global Strain – strain calculated by using the entire myocardial line length to calculate deformation; can also be computed by averaging the values from the segments Notes No. 49 SIEMENS Healthineers Monitor controls SIEMENS ... Healthineers ... A4C 53 bpm Hide/Show Segment Values – show or hide 56 fps segment values on tracked clips -29% -22% -24% -18% Edit Contours – brings user to ED-ES layout for editing 17% -28% X Delete View – removes view within viewport; removes view, curves, and analysis Cannot undo after deletion! X Single View – brings user to single view layout V 50 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The following options are available in each viewport for the apical four, two and three chamber views. Please note that if Delete View is selected, the user cannot undo deletion. Notes No. 50 SIEMENS Healthineers Tracking analysis – Single View SIEMENS .. : Healthineers' ... Single View displays a summary page for an A4C 08 bpm Tracking Results (A4C) 2 individual view, as opposed to all three views and 66 Tps -35% -21% GLS (%) 25.3 the completed bullseye. 1 20 EF (%) 60.1 -31% -22% CO (I'min) 2.9 EDV (ml) 71.7 ESV (ml) 28.6 1. Viewport – display of currently selected view -19% -20% Bi-Plane Results with contour and segment values; other display LV EF (%) 66.1 options are listed on the bottom right-hand CO (l/min) 3.3 EDV (ml) 20 71.7 corner ESV (ml) 24.3 2. Summary – list of results for currently selected chamber Segmental Strain 3. Curves – curve display for currently selected 3 view (choose results displayed from touch ........................................ screen) 10 20 .................................................................................... 30 TIP: Press the Update key on the control panel to 40 change the currently displayed view. 100 200 300 400 500 600 700 800 900 ms ] 51 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The Single View option on the touch screen displays a summary page for an individual view, as opposed to all three views with the completed bullseye. To access the Single View layout, select the Single View option from the touch screen or monitor controls. Components of the Single View layout include: 1. Viewport – display of the currently selected view with contour and segment values. Select the eye icon to hide/show segment values. Select the pencil icon to edit the contour. Select the bullseye icon to return to the bullseye view. 2. Summary – includes a list of results for currently selected chamber for GLS and Simpson’s Biplane values (choose results displayed from the options on the touch screen) 3. Curves – curve display for currently selected view (choose results displayed from the options on the touch screen) Tip: Press the Update key on the control panel to change the currently displayed view Notes No. 51 SIEMENS Healthineers Single View touch screen SIEMENS . Healthineers ... Options available on the Single View touch Review screen include: 2D Heart AM • Timing / Phase – changes timing / phase Exit parameters displayed • Curve – changes Curve parameters Hide Contours displayed Beats Analyzed Hide Contours – removes contour display RV • from all views Timing / Phase Curve Segment .. LA • Chamber selection – select currently displayed chamber results Single View Bullseye View ED-ES View • Exit – select to come out of 2D HeartAI AVC and back to active imaging Cine Move+ • ED-ES View – return to ED-ES View layout to edit contours for current view Rotate to adjust Rotate to Cine aortic valve through closure frames 52 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Options available on the Single View touch screen include: • Timing / Phase – changes timing / phase parameters displayed • Curve – changes Curve parameters displayed • Hide Contours – removes contour display from all views • Chamber selection – select currently displayed chamber results (LV and LA are only available from tracking analysis; RV and RA are available from two frame analysis) • Exit – select to come out of 2D HeartAI and back to active imaging • ED-ES View – return to ED-ES View layout to edit contours for current view Notes No. 52 SIEMENS Healthineers Tracking – Bullseye View for the LA SIEMENS ... Healthineers' ... To obtain the tracking results for the left atrium, select the LA option on the touch screen while in A4C Volume [ mi/m2 ] Bullseye View 2 40 30 Tracking results for the LA includes the following: ......................... 20[ ............... 1. LA viewports – the LA is only tracked in the A2C 10 apical 4 and 2 chamber views 200 400 600 800 1000 2. Curve – LA curve display (choose value from 1 Lms ] Tracking Results (Summary) touch screen) LA Volume Global Strain AVG GLS Cond (%) PT3.1 AVG GLS Res (%) 24.0 A3C AVG GLS Cont (%) solps -10.9 Curve AVG ESV (ml/m2)* 32.1 Volume 3 3. Summary – list of LA chamber results from analysis 53 Unrestricted © Siemens Healthineers 2023 Speaker Notes: In order to obtain the tracking results for the left atrium, the user must select the LA option on the touch screen while in Bullseye View (LV will be the default when entering Bullseye View). Tracking results for the LA include the following: 1. LA Viewports – display of LA with contours; the LA is only tracked in the apical 4 and 2 chamber views 2. Curve – LA curve display (change the value of displayed results from the touch screen) 3. Summary – list of the LA chamber results from tracking analysis Note: There is no bullseye analysis for LA strain. LA strain is analyzed as three segments, as discussed on slide 8. Notes No. 53 SIEMENS Healthineers Report layout - bullseye SIEMENS . Healthineers ... For results, select the 2D HeartAI option on the SIEMENS Healthineers Patient Report left-hand side of the report Patient History 20 Heart Nl · Cardiac Last Single Beat Analysis LV End Systolic Strain [%] LV • The last captured analysis is displayed on the 2D Heart Nl 40 Heart Nl AVG EF Overall GLS -18.9 report bullseye M-mode MAC GLS -19.8% ADV A2C GLS 17.4 A3C GLS -19.6 4 Bullseye displays the Timing / Phase value LV PSD • AVC 378 ms selected in system configuration or during the PA RV Diastolic Function exam from the touch screen TV Images Segments cannot be removed from the bullseye Summary Comments • Summary A4C in the report Value Method 50.6 45.5 45.5 55.7 55.7 • A GLS value for all three chambers and the GLS -17.8 % -15.7 -15.7 19.8 -19.8 Overall GLS are listed in the LV summary with co 4.0 Min the bullseye Summary Collapse All Export to PDF Note: If an analysis is not captured during the Store Report Edited Value " exam, the bullseye results will not populate to the report. 54 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The report includes a separate section for 2D HeartAI which can be accessed from the menu on the left-hand side of the report. • The last single beat analysis is displayed on the report bullseye • Bullseye displays the Timing / Phase value selected in system configuration or during the exam from the touch screen • Segments cannot be removed from the bullseye in the report • A GLS value for all three chambers and the Overall GLS are listed in the LV summary with the bullseye Notes No. 54 SIEMENS Healthineers Report layout - worksheet SIEMENS . Healthineers ... Patient Report The worksheet includes the last five instances healthingers Patient History captured Summary 20 Heart N MC 4D HeartN LV Value Method • Result values can not be edited, only deleted M-mode EF 50.6 % 45.5 45.5 55.7 55.7 Avg ADV GLS Method can be set to Average, Last, First 17.8% 15.7 15.7 -19.8 -19.8 • LV CO 4.0 amin 3.8 3.8 • Results are listed by chamber (A4C, A2C, A3C) MV EDV 165.1 m2 1725 172.5 157.7 157.7 81.9 ml 94.0 RV Diastolic Function ESV 94.0 69.9 69.9 • Store Report – saves an image of the entire TV HR 48 bpm 48 Images EDVIBSA 78.3 slim 81.8 81.8 74.8 74.8 report Summary Comments ESVIBSA 38.9 malim 44.6 44.6 33.2 33.2 • Export to PDF – exports a pdf version of the AZC LV Value 50 Method report to a USB 66.6 % 67.3 67.3 62.2 Avg Print Report – prints the report to the GLS -20.0 20.2 -20.2 -22.0 -17.4 • configured printer Summary Collapse All Export to PDF Store Report Hamit Suport Edited Value " 55 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The worksheet includes the last five instances captured • Result values can not be edited, only deleted • Method can be set to Average, Last, First • Results are listed by chamber (A4C, A2C, A3C) • Store Report – saves an image of the entire report • Export to PDF – exports a pdf version of the report to a USB • Print Report – prints the report to the configured printer Notes No. 55 SIEMENS Healthineers Report layout - Summary SIEMENS . Healthineers ... The Summary page is displayed when Summary SIEMENS Healthineers Patient Report Patient History LV End Systolic Strain [%] LV is selected from the Report page or the touch Cardiac AVG EF 56.2 % Overall GLS -18.9% screen 2D Heart N A4C GLS -19.8 % 40 Heart N A2C GLS -17.4 % 19.6 % GLS, EF, and Volume measurements listed for M-mode 72 ms • AOV AVC 378 ms each chamber LV MV Bi-Plane results from apical 4 and 2 chamber PA • RTY Dlastolk Function views TV Summary Images MC A2C si-Plane Summary Comments LV LV • Select Edit Report to return to the report LV EF 50.6 % EF 66,6 % EF 50.7 % 59,2 % GLS -17.8 % GLS -20.0 % 4.7 Mmin worksheet CO 4.0 u/min CO 5.2 Mnin 171.7 m EDY 165.1 ml EDV 179.6 ml 123.5 ml 70.2 m ESV 81.9 ml ESV EDY 60.0 ml EDVIBSA 81.4 / HR 48 6pm HR 44 bom HR 45 bpm ESVIESA 33.3 m//m' 78.3 milm' EDVIBSA 85.2 mins EDWBSA 58.6 millmt ESWIRSA 38,9 milm' ESVIBSA 28.5 mins ESWBSA 29.2 mllm: Edit Report Collapse All Export to PDF Store Report 56 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The Summary page is displayed when Summary is selected from the Report page or the touch screen • GLS, EF, and Volume measurements listed for each chamber • Bi-Plane results from apical 4 and 2 chamber views • Select Edit Report to return to the report worksheet Notes No. 56 SIEMENS Healthineers Summary SIEMENS . Healthineers ... • Review cardiac strain principles • Explain image acquisition for cardiac strain • Discuss 2D HeartAI workflow • Evaluate cardiac strain analysis and report 57 Unrestricted © Siemens Healthineers 2023 Speaker Notes: No speaker notes. Notes No. 57 SIEMENS Healthineers 2D HeartAI Key Takeaways SIEMENS . Healthineers ... AI Deep Machine Learning Physio and Non-physio Contrast Imaging Analysis Integration Workflow • Strain analysis for contrast • Auto view recognition • Analysis for irregular heart imaging • Auto contour placement beats can be performed • Includes auto view • Flexibility to edit when • Ability to change ED/ES and detection and auto contour needed AVC timings placement • Average up to 5 beats • Only vendor to have • Only vendor to have non- contrast feature! physio feature! 58 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The following are key takeaways to remember when discussing 2D HeartAI with customers. Notes No. 58 SIEMENS Healthineers Trademarks and disclaimers The products/features mentioned in this document may not be commercially available in all countries. Due to regulatory reasons their future availability cannot be guaranteed. Please contact your local Siemens Healthineers organization for further details. ACUSON O r i g in i s a trademarks of Siemens Medical Solutions USA, Inc. At Siemens Healthineers, our purpose is to enable healthcare providers to increase value by empowering them on their journey towards expanding precision medicine, transforming care delivery, and improving patient experience, all enabled by digitalizing healthcare. An estimated five million patients worldwide everyday benefit from our innovative technologies and services in the areas of diagnostic and therapeutic imaging, laboratory diagnostics and molecular medicine as well as digital health and enterprise services. We’re a leading medical technology company with over 120 years of experience and 18,500 patents globally. With over 50,000 employees in more than 70 countries, we’ll continue to innovate and shape the future of healthcare. Siemens Healthineers Headquarters Manufacturer Siemens Healthcare GmbH Siemens Medical Solutions USA, Inc. Henkestr. 127 Ultrasound 91052 Erlangen, Germany 22010 S.E. 51st Street Phone: +49 9131 84-0 Issaquah, WA 98029, USA siemens-healthineers.com Phone: 1-888-826-9702 siemens-heathineers.com/ultrasound 59 Unrestricted © Siemens Healthineers 2023 Notes No. 59 SIEMENS Healthineers Resources SIEMENS . Healthineers ... 1. Yingchoncharoen, Teerapat, et al., JASE (2013) 26: 185-91 2. Ashish, Kumar, et al., IJC Heart & Vasculature (2019) 22: 48-49 3. Espen Boe, Otto, et al., European Heart Journal (2022) 23;9: 1169-1170 4. Pathan, F., et al., J Am Soc Echocardiography (2017) 30; 1: 59-70 60 Unrestricted © Siemens Healthineers 2023 Speaker Notes: No speaker notes. Notes No. 60 SIEMENS Healthineers Thank you for your enthusiasm! SIEMENS. Healthineers ... Questions? 61 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Questions? Notes No. 61