ACUSON P500 Ultrasound System 3.0 syngo Velocity Vector Imaging (VVI) Presentation

SIEMENS Healthineers SIEMENS Healthineers ACUSON P500 Ultrasound System syngo® Velocity Vector Imaging Technology TM 1 3.0 SW Release Unrestricted © Siemens Healthineers 2022 Unrestricted Speaker Notes The purpose of this presentation is to provide instructions on the use of syngo® Velocity Vector Imaging TM Technology with the ACUSON P500 ultrasound system. 1 SIEMENS Healthineers Objectives SIEMENS Healthineers ... • Review cardiac strain principles and relevance • Explain image acquisition for cardiac strain • Discuss syngo VVI workflow • Evaluate cardiac strain analysis SIEMENS 2 Unrestricted © Siemens Healthineers 2022 Speaker Notes We will begin with a brief review of cardiac strain principles and its relevance in echocardiography. 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) 1 Tracked via speckle-tracking Lo • echocardiography (STE) • Expressed as percentage (%) • Strain (€) = 𝐿1 − 𝐿0 𝐿0 3 3 Unrestricted © Siemens Healthineers 2022 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. 3 SIEMENS Healthineers Three strain principles SIEMENS Healthineers ... • Radial or Transverse (47 ± 15%)1 Global Radial Strain (GRS) • Circumferential (-23 ± 3%)1 Global Circumferential Strain (GCS) • Longitudinal (-20 ± 3%)1 radial circumferential longitudinal Global Longitudinal Strain (GLS) Sources | 1. Yingchoncharoen, Teerapat, et al., JASE (2013) 26: 185-91 4 4 Unrestricted © Siemens Healthineers 2022 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 4 SIEMENS Healthineers Parameters of myocardial function SIEMENS Healthineers .... • 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: is the rate of change in strain and is expressed as 1/sec or sec-1 5 Unrestricted © Siemens Healthineers 2022 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 syngo VVI, the user has the ability to choose between each of the parameters for analysis. Strain is the most commonly used parameter for cardiac analysis. 5 SIEMENS Healthineers Global longitudinal systolic strain (GLS) SIEMENS Healthineers' . Clinical relevance • Studies suggest reduced Prognostic value of global longitudinal strain in heart failure subjects: A recent prototype strain is associated with Kumar Ashish a, Mohammed Faisaluddin b, Dhrubajyoti Bandyopadhyay c+, Adrija Hajra d, Eyal Herzog e Crozer-Chester Medical Center, Philadelphia, USA mortality due to b Deccan College of Medical Sciences, Hyderabad, India Mount Sinai St Luke's Roosevelt Hospital, New York, USA d IPGMER, SSKM, Kolkata, India e Mount Sinai St Luke's Roosevelt Hospital, Icahn School of Medicine at Mount Sinai, New York, USA cardiovascular events ARTICLE INFO and HFpEF subgroups the strain has been found to have an important Article history: prognostic value that is independent of LVEF. Nonetheless, this study in- Received 19 October 2018 cluded only patients with acute heart failure, so it is unknown whether • GLS adds prognostic value 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 in prediction of adverse Keywords: having HFPEF, and 2302 controls showed patients with HFpEF had sig- 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 cardiovascular outcomes Sources | 2. Ashish, Kumar, et al., IJC Heart & Vasculature (2019) 22: 48-49 6 Unrestricted © Siemens Healthineers 2022 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 6 SIEMENS Healthineers Objectives SIEMENS Healthineers ... • Review cardiac strain principles and relevance • Explain image acquisition for cardiac strain • Discuss syngo VVI workflow • Evaluate cardiac strain analysis SIEMENS 7 Unrestricted © Siemens Healthineers 2022 Speaker Notes Next, we will explain image acquisition for cardiac strain. 7 SIEMENS Healthineers syngo VVI SIEMENS ..... Healthineers ... • syngo VVI is a clinical software P4-2 application used to visualize, Cardiac 100% MI 0.83 measure and assess myocardial TIS 0.7 TIB 0.7 motion and mechanics using DTCE Low Dyn R 60 GB THI 3.5 MHZ acquired 2D clips 11 4B 53 fps 64 bpm • Tracks and estimates tissue velocity and deformation along a user-defined outline (contour) of the myocardium HC US MSC S SET 8 8 Unrestricted © Siemens Healthineers 2022 Speaker Notes Before we begin a cardiac strain analysis, it’s important to understand what the syngo VVI software does. The syngo VVI clinical software application is used to visualize, measure and assess myocardial motion and mechanics using acquired 2D clips. The application tracks and estimates the tissue velocity and deformation along a user-defined outline (contour) of the myocardium. 8 SIEMENS Healthineers Cardiac strain acquisition configuration SIEMENS Healthineers ... Acquisition rate (frame rate) Configuration Clip Store General 1 3 1. Select Config on General 2 Custom Keys Compression: Low Medium High Patient Display Exam control panel Soft Keys Capture Type: · Prospective Retrospective M&R Exam Report Text Annotation Clip Length · Time Y se 2. Select Clip Store Body Marker Review Wireless Network Beat 1 beats Service 3. Select Low for Clip Store 2 Report Archive OR-wave only -wave delay: msec Security Printer compression type Browser Barcode Utility Stress Echo SieSe 4. Select Save 1 Config Help Save Cancel 9 9 Unrestricted © Siemens Healthineers 2022 Speaker Notes Before beginning a cardiac strain acquisition for syngo VVI analysis on the ACUSON P500 ultrasound system, the Compression Rate must be set to Low. The reason for this is cardiac strain clip captures must have frame rates higher than 30 frames per second (fps). To adjust Compression type: 1. Select Config 2. Select Clip 3. Select Low under Compression 4. Select Save 9 SIEMENS Healthineers Cardiac strain image acquisition SIEMENS ..... Healthineers ... • Ensure entire area of 5P1 Adult Echo interest is maintained in Tx Power 100% MI 0.80 TIS 0.4 TIB 0.4 field of view (FOV) DTCE Med Dyn R 60 dB THI 3.7 MHZ • Optimize 2D image settings 42 fps 37 bpm • A full R-R wave must be contained in data set for quality analysis • Clips should not exceed 10 heart cycles or 10 seconds HC US MSC S SET 10 10 Unrestricted © Siemens Healthineers 2022 Speaker Notes Image acquisition must include the entire area of interest because syngo VVI analyzes 2D images to determine motion within the imaging plane. For example, if the left ventricle is the structure of interest, the entire left ventricle should be included in the field-of-view (FOV). It should be noted that significant motion of the structure throughout systole and diastole can complicate the analysis. As a result, ensure the FOV takes the full heart motion into consideration. Asking the patient to hold their breath can help reduce unwanted motion. Optimize 2D image settings so that the myocardial speckle pattern is well visualized for tracking. A full R-R wave must be contained in the dataset for quality analysis. If a full cardiac cycle is not captured, the application cannot perform a clinically relevant analysis. Clips should not exceed 10 heart cycles or 10 seconds. The longer the clip, the longer the analysis will take. 10 SIEMENS Healthineers Cardiac strain image acquisition SIEMENS ..... Healthineers ... Acquisition with ECG (physio) Acquisition without ECG (physio) • Use a beat capture • Use a timed capture • Multiple heart cycles are • Limited to 700 frames allowed • Recommended clips should contain 6 frames minimum to 700 frames maximum 19 cm HC US MSC S SET 11 11 Unrestricted © Siemens Healthineers 2022 Speaker Notes When obtaining a clip for cardiac strain acquisition, it is recommended to use a beat capture with clips ranging from 6 frames as a minimum to 700 frames as a maximum. However, clip capture acquisitions without an electrocardiogram (ECG) are allowed for cardiac strain analysis but it is limited to 700 frames and further cardiac timing modifications are necessary. Modifying cardiac timing will be discussed later in this presentation. 11 SIEMENS Healthineers Cardiac strain image acquisition SIEMENS ..... Healthineers ... • 60 – 90 frames per second (fps) is P4-2 ideal for optimal tracking results Cardiac 100% MI 0.83 40 fps is the minimum frame rate TIS 0.7 • 29.31.7 CE Low and 150 is the maximum frame n R 60 dB 11 3.6 MHZ fps 70 – 90 frame rate range is rate bpm • 40 – 80 fps are widely used in recommended for optimal clinical literature3 tracking results 40 frames per second is the minimum frame rate 150 frames per second is the maximum frame rate Sources | 3. Voigt, Jens-Uwe, et al., J Am Soc Echocardiography (2015) 28: 183-193 HC US MSC S SET 12 12 Unrestricted © Siemens Healthineers 2022 Speaker Notes Frame rate during image acquisition is an important determinant for the reliability of 2D speckle tracking echocardiography. In this slide, we review the optimal frame rate range. High frame rates do not necessarily improve tracking performance. Increasing the frame rate past the maximum limits can cause a decrease in tracking performance. The use of low frame rates does not inhibit the ability to perform strain analysis, but it can limit the diagnostic value of the analysis because of the loss of speckles due to undersampling. Note: Frame rate is commensurate to the patient’s heart rate. Higher heart rates should have higher frame rates. 12 SIEMENS Healthineers Global longitudinal strain (GLS) acquisition SIEMENS ..... Healthineers ... SP1 SP1 Adult Echo Adult Echo Adult Echo Tx Power 100% Tx Power 100% Tx Power 100% M 0.79 M 0.79 M 0.79 FIS 0.0 FIS 0.0 FIS 0.0 TIB O.O TIB O.O TIB 0.6 DTCE Med OTCE Med OTCE Med Dyn R 65 di Dyn R 65 dBl Dyn R 65 dBl TH 3.7 MHZ TH 3.7 MHZ TH 3.7 MHZ 12 0B 56 1ps 56 1ps 56 1ps 53 bpm 67 bpm 56 bom Apical 4 Chamber Apical 2 Chamber Apical 3 Chamber 13 Unrestricted © Siemens Healthineers 2022 Speaker Notes The views necessary for a complete global longitudinal strain (GLS) analysis include the apical 4 chamber (A4C), apical 2 chamber (A2C), and apical 3 chamber (A3C). It should be noted that a single apical view can be analyzed but the bull’s eye map will not be complete. 13 SIEMENS Healthineers Global circumferential strain (GCS) acquisition SIEMENS ..... Healthineers ... SP1 Adult Echo Tx Power 100% Tx Power 100% 1 0.81 1 0.81 FIS 0.8 TIS 0.8 TIB 0.8 TIB 0.8 TIB 0.8 OTCE Low OTCE Low DICE Low Oyn R 60 dfl Oyn R 60 dal 3.6 MHZ 3.0 MHZ 3.6 MHZ 11 08 11 08 11 08 56 1ps 56 1ps 75 bpm PSAX MV PSAX PM PSAX APEX 14 14 Unrestricted © Siemens Healthineers 2022 Speaker Notes The views necessary for a complete global circumferential strain (GCS) analysis include the parasternal short axis at the mitral valve (PSAX MV), parasternal short axis at the papillary muscle (PSAX PM) and the parasternal short axis view at the apex (APEX). It should be noted that a single parasternal short axis view can be analyzed but the bull’s eye map will not be complete. 14 SIEMENS Healthineers Cardiac strain acquisition SIEMENS Healthineers .... syngo VVI does not support the following acquisition types: • 2D color Doppler clips • Secondary capture images or clips • M-mode of Doppler images • Static captures • 2D live dual clips • 2D dual clips 15 15 Unrestricted © Siemens Healthineers 2022 Speaker Notes It is important to know there are certain clip capture acquisitions that are not compatible with syngo VVI. Some of the incompatible acquisition types include clips with color Doppler, M-mode, spectral Doppler, static and secondary captures, 2D / live dual, and 2D dual clips. 15 SIEMENS Healthineers Objectives SIEMENS Healthineers ... • Review cardiac strain principles and relevance • Explain image acquisition for cardiac strain • Discuss syngo VVI workflow • Evaluate cardiac strain analysis SIEMENS 16 Unrestricted © Siemens Healthineers 2022 Speaker Notes We will now discuss syngo VVI workflow. 16 SIEMENS Healthineers syngo VVI workflow SIEMENS Healthineers ... 1. Press Review on left Patient side of control panel to Exam select images for VVI analysis 1 Review Report Browser Config Help HC US MSC S SET 17 Unrestricted © Siemens Healthineers 2022 Speaker Notes To select clips for syngo VVI analysis the user must first enter Review from the control panel to choose single or multiple 2D clips. Select all images needed for VVI analysis. For example, if the user wants to perform a GLS analysis with a completed bull’s eye map, an apical four chamber, apical two chamber and apical three chamber view should be selected. Once syngo VVI is activated, the user cannot select more images without exiting the VVI application completely and entering Review again. Once all images are chosen, select Show Selected. This allows the user to view and confirm which images have been selected for analysis. Finally, select syngo VVI to activate the analysis package. Note: Multiple images for analysis can be selected, but only one view can be processed at a time. 17 SIEMENS Healthineers syngo VVI workflow SIEMENS ..... Healthineers ... 2 2. Select images from Review touch screen Select all Clear all 3. Press Show Selected 3 Show Selected Show from the touch screen Teaching AHP 4. Press syngo VVI syngo VI 4 Archived Report Report Return to Imaging Reset Set Start Marker Rate 1 Set End Save Marker 77184 Layout Full Screen Page Select | Deselect Print Export Delete 2x2 Off 111 Play Play HC US MSC S SET 18 18 Unrestricted © Siemens Healthineers 2022 Speaker Notes Select all images needed for VVI analysis. For example, if the user wants to perform a GLS analysis with a completed bull’s eye map, an apical four chamber, apical two chamber and apical three chamber view should be selected. Once syngo VVI is activated, the user cannot select more images without exiting the VVI application completely and entering Review again. Once all images are chosen, select Show Selected. This allows the user to view and confirm which images have been selected for analysis. Finally, select syngo VVI to activate the analysis package. Note: Multiple images for analysis can be selected, but only one view can be processed at a time. 18 SIEMENS Healthineers syngo VVI workflow SIEMENS ..... Healthineers ... • For Global Longitudinal Strain MI 0.7B (GLS) select A4C, A2C and A3C TIS O.J TIB 0.7 OTCE Low Dyn R 60 dB THI 3.6 MHZ images • Chosen clips will be outlined in blue HC US MSC S SET 19 19 Unrestricted © Siemens Healthineers 2022 Speaker Notes After choosing images and pressing Show Selected, the user can confirm the thumbnails. For global longitudinal strain (GLS) select apical 4 chamber (A4C), apical 2 chamber (A2C) and apical 3 chamber (A3C) views. 19 SIEMENS Healthineers syngo VVI workflow SIEMENS ..... Healthineers ... 520 • For Global Circumferential MI D.B2 Strain (GCS) PSAX MV, PSAX TISOJ TIB O.J DTCE Low Dyn R 60 de THI 3.5 MHZ PM and APEX images O dE 32 fps • Chosen clips will be outlined in blue HC US MSC S SET 20 20 Unrestricted © Siemens Healthineers 2022 Speaker Notes After choosing images and pressing Show Selected, the user can confirm the thumbnails. For global circumferential strain (GCS) select parasternal short axis at the mitral level (PSAX MV), parasternal short axis view at the papillary muscle level (PSAX PM), and parasternal apex view (APEX). 20 SIEMENS Healthineers syngo VVI workflow SIEMENS ..... Healthineers ... Assign thumbnail images accordingly • Use SET key to place images • To delete an image, select the ‘X’ in upper right of image in 32 hpical X Sax Atrium thumbnail image box • Select the gray arrow displayed in lower right corner O of screen to proceed O HC US MSC S SET 21 21 Unrestricted © Siemens Healthineers 2022 Speaker Notes Once images have been chosen and syngo VVI has been initialized, the views have to be assigned accordingly. To assign thumbnail images: • Identify the thumbnails in the top left corner of the screen, use the SET key to choose a thumbnail image (This is not a click and drag action) • In the lower right corner of the screen, assign the thumbnail image to the corresponding view using the SET key (A4C, A2C, A3C as displayed in this example) When all views have been properly identified, select the gray arrow in the lower right corner of the screen to proceed. If an incorrect view has been assigned, the user can either use the “X” beside the thumbnail to delete the view and repeat the image assignment, or the user may simply repeat the image assignment steps to overwrite an incorrectly assigned image. 21 SIEMENS Healthineers syngo VVI SIEMENS ..... Healthineers ... syngo VVI supports strain analysis Sax on the following views Apical X Atrium A40 SAX MV Atrium • Apical X ➢ Complete apical analysis provides full bull’s eye map A2C SAX PM • Short axis (SAX) X RV RV ➢ Complete short axis analysis A3C SAX APEX provides full bull’s eye map IX • Left atrium (Atrium) O • Right ventricle (RV) 22 22 Unrestricted © Siemens Healthineers 2022 Speaker Notes syngo VVI supports strain analysis on the following views: • Apical 4 chamber (A4C), apical 2 chamber (A2C) and apical 3 chamber (A3C) ➢ Analysis of all 3 apical views provide a complete bull’s eye map for global longitudinal strain (GLS) • Short axis at the level of the mitral valve, papillary muscle and apex ➢ Analysis of all 3 short axis views provide a complete bull’s eye map for global circumferential strain (GCS) • Atrium – left atrium strain analysis is performed from the apical 2 chamber view • Right ventricle (RV) – RV strain analysis is performed from the apical 4 chamber view 22 SIEMENS Healthineers Gamma slider gain control (dB) SIEMENS ..... Healthineers ... 40/85 034/1292/2811 ms. ESO FROSK VEND CV 40/85 034/1292/2811 JIS. ESO AOSK VC10 KV ACUSON P509 4-2 P4-2 -Settings- Cardiac Cardiac 100% 100% -.- MI 0.83 MI 0.83 TIS 0.7 TIS 0.7 TIB 0.7 TIB 0.7 DICE Low DTCE Low Dyn R 60 dB Dyn R 60 dB THI 3,6 MHZ THI 3.6 MHZ Endo+Epi X 11 dB 11 dB 68 fps 58 fps 64 bpm 64 bpm End End Set Set Seti -MMode Contour If necessary, to modify the gain setting, click and drag the Gamma slider to the right or left to adjust the -Segmental Analysis- overall gain 23 23 Unrestricted © Siemens Healthineers 2022 Speaker Notes The Gamma slider control allows the user to optimize the gain setting while in the syngo VVI application. To adjust the Gamma slider, click and drag the slider to the right or left to make any necessary adjustments. 23 SIEMENS Healthineers syngo VVI workflow SIEMENS ..... Healthineers ... Three-point method • Identify placement guide for A4C 3. positioning contour markers 040/85 034/1292/2811 ms. ES O PROSK VC10 ICV Setting? P4-2 Cardiac 100% Endo+Epi • See trackball controls for MI 0.83 TIS 0.7 3 TIB 0.7 positioning contour markers DTCE Low 2.6 Dyn R 60 dB THI 3,6 MHZ 11 dB • Press SET key to place first 58 fps 64 bpm segmental Analysis and second marker at annuli 1 2 • Press UPDATE key to “End” trace at the apex End Set Set 24 Unrestricted © Siemens Healthineers 2022 Speaker Notes To draw a three-point method contour in the apical 4 chamber view: • The VVI application first takes the user to an end systolic frame to perform the initial drawing of the contour • Begin by placing the first position marker at the basal septal region with the left or right Set key • Place the next marker at the basal lateral region with the left or right Set key • Place the last marker in the apical region using the Update key • Select the Update key or double click the left or right Set key to track • The end diastolic contour appears and the user can confirm the trace or edit markers if necessary (use of the CINE function allows scrolling through the frames to check the contour tracking) • Again, select the Update key or double click the left or right Set key to progress to analysis Note: The placement guide on the bottom right-hand corner of the monitor demonstrates which trackball controls to use and what order to place the markers for the three-point method. 24 SIEMENS Healthineers syngo VVI workflow SIEMENS ..... Healthineers ... Manual trace method • Using SET key, place markers 040/85 034/1292/2811 ms. ESO in a clockwise pattern starting FROSK VEIO IC ACUSON P500 -Settings P4-2 Cardiac at basal septum 100% Endo+Epi MI 0.83 TIS 0.7 TIB 0.7 DTCE Low • To complete the trace, press Dyn R 60 dB THI 3.6 MHZ 11 dB UPDATE key to anchor 58 fps 64 bpm • To process trace, double-click SET key or select Start Analysis icon for systole and Delete/Calculate Set! Set then diastole TIP Recommend at least 7-11 markers for apical traces 25 Unrestricted © Siemens Healthineers 2022 Speaker Notes To create a manual trace: • The VVI application first takes the user to an end systolic frame to perform the initial drawing of the contour • Begin by placing the first marker in the basal septum region just beyond the annulus • Press either the left or right SET key to place each marker and continue defining the contour along speckled edge of the myocardium in a clockwise pattern • To complete the trace, press the UPDATE key to anchor the final marker • Double click either SET key or click the Update key • The VVI application will display the contour at end diastole, where the user can edit the contour markers if necessary (use of the CINE function allows scrolling through the frames to check the contour tracking) • Again, double click either SET key or click the Update key to progress to analysis 25 SIEMENS Healthineers syngo VVI workflow SIEMENS ..... Healthineers ... Performing endocardial and epicardial trace 1. Select Endo+Epi box 040/85 034/1292/2811 ms. ES O FROSK VC10 ICV ACUSON P500 2. Select green arrows on right P4-2 Cardiac 1 MI 0.83 EndatEpi X side of image to increase or TIS 0.7 TIB 0.7 decrease thickness DTCE Low Dyn R 60 dB THI 3.6 MHZ between endocardial and 11 dB 3 58 fps 64 bpm epicardial traces 2 3. To process trace, double- click SET key or select Start Delete/Calculate IX Analysis icon for systole Set Set 14 cm and then diastole 26 26 Unrestricted © Siemens Healthineers 2022 Speaker Notes The syngo VVI application allows the user to create an endocardial and epicardial trace simultaneously. 1. Select the Endo+Epi box under the Settings area on the right side of the monitor 2. Click the green arrows on the right side of the image to increase or decrease the distance between the endocardial and epicardial contour trace 3. To process the trace, double click the SET key or select the Update key to progress to analysis 26 SIEMENS Healthineers syngo VVI workflow SIEMENS ..... Healthineers ... Edit marker placement Edit the desired marker using 0028/85 ed FROSK VC10 ICV ACUSON P500 • P4-2 SET key to drag and reposition Cardiac 100% MI 0.83 ➢Red markers adjust a larger TIS 0.7 TIB 0.7 portion of the contour DTCE Low Dyn R 60 dB THI 3.6 MHZ ➢Blue markers adjust a smaller 11 dB 58 fps 64 bpm portion of the contour 27 Unrestricted © Siemens Healthineers 2022 Speaker Notes To edit a marker position, move the cursor over the desired marker, press either SET key, reposition the marker to the desired area and press the SET key again to anchor. • To edit the contour for a larger portion of the trace, select and drag a red marker • To edit the contour for a small segment, select and drag a blue marker 27 SIEMENS Healthineers syngo VVI workflow SIEMENS ..... Healthineers ... Delete a contour 1. Select X next to view 029/85.017/0947/2811 ms. (64 bpm).O ... P43 2. Select OK Cardias MI0.83 TIS 9.7 Endo +Epi Delete Selected Contour Confirm? SD Contour 0.00 S Dy Analyai 2 ES Border ED Bord 369.00 1 OK Cancel DIS-SYR 21.9 14. 22.9 17.6 EF vonpeuon adeus 102030405 06075 Syst. Endo Longitudi 20 % 28 Unrestricted © Siemens Healthineers 2022 Speaker Notes To delete a contour that has been analyzed, first select the X next to the view. A confirmation window will appear, select OK to delete the selected contour. The user will be returned to begin a new contour for the view which was just deleted. Note: If a new contour is drawn without deleting the previous contour, the results will be averaged and therefore inaccurate. 28 SIEMENS Healthineers syngo VVI workflow SIEMENS ..... Healthineers ... Modify cardiac timing markers • Select Sequence/M-mode 29.00 EndoGLS 23.20 EndoGCS icon under MMode in control 17.40 11.60 settings- 5.80 settings 0.00 5.80 ➢ eD marker should align with 11.60 Endo+Epi -17.40 ................................. peak on red Volume curve -23.20 S DA -29.00 ms 375 750 125 1500: 1875 2250 2625 ➢ eS marker should align with 180.00 Volume dV/dt 567.00 168.70 453.60 MMode trough on red Volume curve 157.40 340.20 146.10 226.80 134.80 113.40 -Contour • Note that any curve on CHS DY 123.50 eD. 0.00 112.20 1125 1500 -113.40 graphs can be hidden by -Segmental Analysis- 100.90 -226.80 89.60 -340.20 toggling its colored box 78.30 453.60 % 67.00 ml % ms 375 750 125 1500: 1875 ml/ 2250 2625 -567.00 *continued on next slide 29 Unrestricted © Siemens Healthineers 2022 Speaker Notes To edit cardiac timing for the end diastolic and end systolic marker positions, select the Sequence / M-mode icon in the control settings on the right side of the monitor. • The end diastolic marker (eD) should align with the peak volume on the red Volume curve • The end systolic marker (eS) should align with the lowest volume on the red Volume curve Note: Any curve on the graphs can be hidden by selecting the corresponding curve’s color box next to the graph. 29 SIEMENS Healthineers syngo VVI workflow SIEMENS ..... Healthineers ... Modify cardiac timing markers referencing Cine 2D clip • Freeze 2D reference image 049/85 • Press SET key to select and drag ED then the ES red A4C bar to desired location ➢ Watch cine behavior of 2D image to align marker Reverse X placement • Press in the top right corner to proceed Teyou selector 30 Unrestricted © Siemens Healthineers 2022 Speaker Notes There are two separate references we can use to determine marker placement for cardiac timing. Here we describe how to use the Cine behavior of the 2D clip as a point of reference. The mechanical timing of wall motion and the mitral valve opening and closure are seen as markers are moved within the gray box. • First, press FREEZE on the control panel to stop the 2D reference image • Hover over the end diastole (ED) red bar and press the SET key to drag and reposition; click the SET key again to anchor the ED marker • Hover over the end systole (ES) red bar and press the SET key to drag and reposition; click the SET key again to anchor the ES marker • Select the arrow in the top right corner of the monitor to proceed with analysis; the user is taken back to the analysis page with updated results for the new marker placement 30 SIEMENS Healthineers syngo VVI workflow SIEMENS ..... Healthineers ... Modify cardiac timing markers referencing M-mode display • Freeze 2D reference image A4C • Press SET on 2D clip to Reverse X enable drawing M-line • Press SET key to select and drag ED then the ES red bar to desired location • Press in the top right corner to proceed 31 Unrestricted © Siemens Healthineers 2022 Speaker Notes Here we demonstrate how to draw the M-mode display as a point of reference for setting cardiac timing markers. Aligning the M-line drawing just beneath the valve opening into the ventricle provides visualization of mechanics for the mitral valve and wall motion. • First, press FREEZE on the control panel to stop the 2D reference image • Move the cursor into the 2D clip and press the SET key; use the pencil cursor to draw the M- line • Hover over the end diastole (ED) red bar and press the SET key to drag and reposition; click the SET key again to anchor the ED marker • Hover over the end systole (ES) red bar and press the SET key to drag and reposition; click the SET key again to anchor the ES marker • Select the arrow in the top right corner of the monitor to proceed with analysis; the user is taken back to the analysis page with updated results for the new marker placement 31 SIEMENS Healthineers syngo VVI workflow SIEMENS ..... Healthineers ... Toggle the M-mode display off / on curve graph analysis When M-mode display -Settings • 076/85. 034/2497/2811 ms. (64 bpm) O is used for editing cardiac timing markers, Endo+Epi X -31.00 2160 M-mode display also SD appears on curve graph analysis Longitudinal Strain (Endo ) s -MMode S Border • To toggle M-mode D Bowl 57.93 Contour -10 display off of curve 1.05 cm -15 B.C5 cm 4.10 cm -Segmental Analysis- -20 3.5 M graphs, select Bkg -25 -30 MMode display icon -35 BB GLS EF Syst. Endo Longitudinal Strain% AAC 10203040506070 . 20 % 32 Unrestricted © Siemens Healthineers 2022 Speaker Notes When the M-mode display is used to edit or set cardiac timing markers, the M-mode display will also appear on the curve graph analysis. To toggle the M-mode display off of the curve graphs, select Background M-mode display icon in control settings. (Note: This icon only appears when the M-mode drawing tool is used for reference in modifying cardiac timing.) 32 SIEMENS Healthineers syngo VVI workflow SIEMENS ..... Healthineers ... Modify cardiac timing markers To analyze a clip without an Current selection does not include a minimum of ECG or with a poor ECG: one heart cycle, please set R-waves. Set R-R interval using SET A4C • key to select and drag R1 then R2 blue bar markers • Press SET key to select and drag ED and ES red bar markers to desired location • Press in the top right corner to proceed Period Selecty HC US MSC S SET 33 33 Unrestricted © Siemens Healthineers 2022 Speaker Notes Although using a stored clip without an ECG is allowed, the syngo VVI application requires the user to identify appropriate cardiac timing. When trying to process a clip without an ECG, the application displays the message outlined in the orange box indicating that syngo VVI requires a minimum one heart cycle for analysis. To set the cardiac cycle timing for the clip the user can reference either the 2D clip Cine method or the M-mode display method as just described: • First, move the pointer in to the gray box and press either SET key • An R1 blue bar marker will appear; hover over the R1 blue bar and press the SET key to drag and reposition and select the SET key again to anchor the marker • Repeat this process for setting the R2 blue bar; note that the R2 marker can only be set to the right of the R1 marker (the R1 and R2 markers represent R-R interval for minimum one heart cycle) • Hover over the end diastole (ED) red bar and press the SET key to drag and reposition as needed; click the SET key again to anchor the ED marker • Hover over the end systole (ES) red bar and press the SET key to drag and reposition as needed; click the SET key again to anchor the ES marker • Press the gray arrow in the top right corner of the display area to proceed 33 SIEMENS Healthineers Objectives SIEMENS Healthineers ... • Review cardiac strain principles and relevance • Explain image acquisition for cardiac strain • Discuss syngo VVI workflow • Evaluate cardiac strain analysis SIEMENS 34 Unrestricted © Siemens Healthineers 2022 Speaker Notes Finally, we will evaluate cardiac strain analysis. 34 SIEMENS Healthineers syngo VVI workflow SIEMENS Healthineers' .... -Settings Gamma Slider Endo+Epi Go to End Systole Endo+Epi X or End Diastole Zoom In/Out Sequence / M-mode S D Pictures Mirroring Selection -MMode Contours or Vectors Segmental Bkg M-mode display Analysis Contour New Trace Swap 3D/2D -Segmental Analysis- Correct ES Border Border Correct ED Border 35 35 Unrestricted © Siemens Healthineers 2022 Speaker Notes It is important to become familiar with the right column for the various control settings available when syngo VVI analysis has been initialized. Gamma Slider- Controls the brightness and contrast settings Endo+Epi- Activates the endocardial and epicardial traces Zoom In/Out: Toggles the 2D clip with contour panel to full screen End Systole- Allows single click to go to end systolic frame End Diastole- Allows single click to go to end diastolic frame Pictures Mirroring -Reverses the orientation of the displayed image Contours or Vectors- Switches parametric over B-mode and toggles contours / vectors / trajectories / B-mode Sequence / M-mode selection- Allows manual edit of R-R wave markers, end diastolic (ED) marker and end systolic (ES) marker Bkg M-mode display- Toggles the M-mode display off/on behind the curve graphs (Note: This icon only appears when the M-mode drawing tool is used for editing cardiac timing) New Trace- Begin a new trace icon Correct ES Border- Correct end systolic border Correct ED Border- Correct end diastolic border Segmental Analysis- Activates segmental analysis page Swap 3D/2D Border –Toggles between 2D border shell and 3D shape shell (Note: This icon only appears with a completed bull’s eye and the default is 2D border) 35 SIEMENS Healthineers Global longitudinal strain (GLS) analysis SIEMENS ..... Healthineers ... Apical 4 chamber 1. 2D Clip with Global Contour 038/65 . 034/1223/2611 ms. (64 bpm). .... 4. longitudinal / 1 circumferential 4 Endo+Epi 2. End-systolic strain curves border and S D end-diastolic MMade Change in LV 5 M 5. border shell -Contour Sy DX volumes over Segmental Analysis N time 3. Graph display 2 WE Average 3 between LVEF, 6. Bull’s eye 6 GLS and shape results function analysis GLS vontenue) adeus.quelsuo2. 1020304050607 Syst. Endo Longitudinal Strain 36 - 20 % 36 36 Unrestricted © Siemens Healthineers 2022 Speaker Notes When a contour is processed, the quantitative data is derived. Here we see the apical 4 chamber view has been analyzed and the bull’s eye map is starting to fill in. 36 SIEMENS Healthineers Global longitudinal strain (GLS) analysis SIEMENS ..... Healthineers ... Apical 2 chamber 1. 2D Clip with 4. Global 001/84 034/0000/2755 ms. (66 bpm), 0 Contour longitudinal / Cardias M10.78 1 circumferential 4 Endo+Epi X 2. End-systolic strain curves border and S D end-diastolic -MMade 5. Change in LV border shell 5 volumes over time 3. Graph display 2 3 25.92 47.00 -335.00 2D mi Average 21.22 54.98 111.01 Paa between LVEF, Constant-Shape contraction -10 304 6 101 6. Bull’s eye GLS and shape -15 87 23 22. 2.60 101.58 28.86 results -20 323 function -25 20.46 DE 30 analysis GLS -35 EF DE 10203040506070 Syst. Endo Longitudinal Strain% 20 -102 102 % , Syst. Transverse s 37 37 Unrestricted © Siemens Healthineers 2022 Speaker Notes After another apical chamber view is processed, we see the bull’s eye map reflecting the additional data for the myocardial wall segments. 37 SIEMENS Healthineers Global longitudinal strain (GLS) analysis SIEMENS ..... Healthineers ... Apical 3 chamber 1. 2D Clip with 4. Global Contour 037/78.034/1191/2571 ms. (70 bpm). ES.O longitudinal / circumferential 1 2. End-systolic 4 Endo+Epi X strain curves border and end-diastolic 5. Change in LV 5 border shell volumes over nencal Analysis time 3. Graph display 2 3 -14.32 47.00 2D ni Average -15.44 -33.54 Peak between LVEF, 54.75 20.4 101 6. Bull’s eye Constant-Shape contraction 80.33 2.79 23.34 6.55 4m GLS and shape -15 18.7/ 6 241 21. results 20 function 25 280 19.9 -13.8 -30 -21.7 43.2 analysis -35 -19.8 GLS FF Syst. Myo Longitudinal Strain% 10203040506070 20 % 102 % 38 38 Unrestricted © Siemens Healthineers 2022 Speaker Notes Once all contours are processed, the quantitative data is derived. In this example, with all views analyzed and processed, the results are displayed and a complete bull’s eye map is seen. The specific results displayed are dependent on the view used to draw the contour. For example, if the apical view, short axis view, atrial view, or RV view are analyzed, the user can select the desired parameter (Velocity, Displacement, Strain, or Strain Rate). 38 SIEMENS Healthineers syngo VVI workflow SIEMENS ..... Healthineers ... If necessary, toggle -Settings P4-2 between the contour’s Cardlac 100'% Endo+Epi X MI 0.83 border, vector, trajectory TIS 0.7 32.01.7 SD or B-mode icons CE Low n R 60 GB Il 3.6 MHZ 4B Pode al Analysis- X nnnitudinal Strain /Endo 1 % HC US MSC S SET 39 39 Unrestricted © Siemens Healthineers 2022 Speaker Notes In the settings column, the user can modify the 2D clip display by toggling the contour’s border, vector, trajectory or B-mode options. Once the vectors are activated, the height of the vectors can be increased and decreased. If desired, the vector size can be reset. 39 SIEMENS Healthineers Global longitudinal strain (GLS) analysis SIEMENS ..... Healthineers ... Bull’s eye map 1. Bull’s eye map for strain results Peak O ES TTP% Phase 1 -20.4 101 2. Numerical result 2 for the segment 18.7 -19.8 13.6 58 21 -23.8 95 of the selected -7.9 21.1 51 20 84 parameter -8.0-10.6 9 5) basal inf/lat 10 17.1 =19.9 13.8 30 32 20 3. Color bar for 11.4 -21.7 13.2 41 32 29 the selected -19.8 30 parameter Syst. Transverse Strain% Syst. Myo Longitudinal Strain% 20 20 % -102 102 % 3 HC US MSC S SET 40 Unrestricted © Siemens Healthineers 2022 Speaker Notes In this slide we take a closer look at a complete bull’s eye analysis of global longitudinal strain. The results are obtained once all segments (views) have been processed and analyzed. Results are dependent on the selected clip and parameters. Segments can be removed. 40 SIEMENS Healthineers LV EF, GLS, and shape function analysis SIEMENS Healthineers ... ...... The 3D volume Average model is a display MyoGCS -14.32 % MyoGLS -15.64 EndoGCS -23.59 of the shape of -05 % EF the LV at end % Constant-Shape contraction EDV 111.39 ml 10 ESV 50.33 ml diastole and end 2.79 GR5 43.84 6.55 cm -15 systole. EDL 3.04 cm 7.86 cm -20 EDDbas 4.08 cm EdLVmass 79.16 The graph EsLVmass 98.04 -25 SD-TS-Syst. 29.0 % SD-LS-Syst. 5.1 displays the -30 relationship -35 between EF, GLS, GLS EF and the shape 10203040506070 function of the left ventricle (LV). 41 Unrestricted © Siemens Healthineers 2022 Speaker Notes The 3D volume shell on the left-hand side is available for display once all three apical views are analyzed providing a complete bull’s eye. The 3D shell gives a visual representation of the change in shape of the left ventricle from end diastole to end systole. The graph to the right represents the relationship between LV ejection fraction, GLS and the shape function (change in shape from end diastole to end systole) of the LV. Numerical values are also provided for GLS, EF and LV volumes. 41 SIEMENS Healthineers EF and GLS relationship SIEMENS ..... Healthineers ... • EF is the change in LV volume Constant- Shape contraction • GLS is the change in LV perimeter • EF and GLS have a linear relationship, which is 2.79 -15 represented by the blue line HC US MSC S SET 42 Unrestricted © Siemens Healthineers 2022 Speaker Notes Let us review the relationship between EF and GLS. EF is the change in LV volume and GLS is the change in LV perimeter. EF and GLS have a linear relationship, meaning that when one goes up or down, the other does so as well. This is represented by the blue line on the graph. 42 SIEMENS Healthineers EF and GLS relationship SIEMENS Healthineers ... 0 -10 Abnormal ? GLS -20 Normal -30 0 50 100 EF 43 Unrestricted © Siemens Healthineers 2022 Speaker Notes The graph on this slide displays EF along the bottom (x) axis and GLS along the side (y) axis. • {click} If the VVI result is plotted in the blue area, EF and GLS are both normal. • {click} If plotted in the orange area, EF and GLS are both abnormal. • {click} However, there are times when the result is plotted in the gray area. In this case EF is normal and GLS is reduced. The next step in LV analysis that would clarify this would be to perform GCS. 43 SIEMENS Healthineers LV shape function SIEMENS ..... Healthineers ... • The shape of the LV plays a part in LV function Constant-Shape contraction • Shape is represented by green curvilinear graph -15 -25 HC US MSC S SET 44 Unrestricted © Siemens Healthineers 2022 Speaker Notes The second part of the graph is the green curvilinear line. The shape function of the LV is represented by this line. As the ventricle contracts, the shape should change from end diastole to end systole and the apex should become more conical. 44 SIEMENS Healthineers LV shape function SIEMENS Healthineers .... Subtle variations of shape, or shape dynamics, with preserved or slight changes of volumes (generally not detectable using e.g. EF) are often sensitive precursors of the macroscopic changes of overt disease.4 EF-60%, GLS-30%, SF-5% EF-60%, GLS -- 26%, SF-0% baly similar EF-60%, GLS- 2314, SP-5% EF-50%, GLS-19%, SF-10% Fig. 1. Example of contraction shapes with same EF and different GLS. From left to right the GLS decreases and the longitudinal function diminishes. A same reduction of GLS. however, can be found when the EF reduces. The decrease of the shape function SF measures the relative contribution of longitudinal regardless of the actual EF values. Sources | 4. Pedrizzetti, Gianni, et al., Journal of Biomechanics (2014) 47.3: 746-749 45 Unrestricted © Siemens Healthineers 2022 Speaker Notes Research has been performed that states that “Subtle variations of shape, or shape dynamics, with preserved or slight changes of volumes (generally not detectable using e.g. EF) are often sensitive precursors of the macroscopic changes of overt disease.”¹ Notice in the illustration that EF is the same for all (60%). However, from left to right GLS decreases as the shape function increases. In a normal ventricle, the shape becomes smaller at systole and the apex becomes more conical in shape. When the shape function is reduced, the GLS appears to be elevated to compensate. This also provides an explanation as to why the EF is still normal. Together, the GLS and EF are working together to make up for a lack in shape function. Sources | 4. Pedrizzetti, Gianni, et al., Journal of Biomechanics (2014) 47.3: 746-749 45 SIEMENS Healthineers LV shape function SIEMENS ..... Healthineers ... • Above green curve: shape is Constant Shape contraction normal (conical) as LV contracts • On green curve: no significant change in shape • Below green curve: LV shape became more round (spherical) in systole Note: EF and GLS may still be normal, even though the shape is abnormal. This is due to the LV working harder to compensate for abnormal shape mechanics. HC US MSC S SET 46 Unrestricted © Siemens Healthineers 2022 Speaker Notes • If the shape function result falls above the green curve, the shape function is normal. • If the shape function result falls on the green curve, there was no significant change in the shape function, which can be an early indicator of LV failure. • If the shape function result falls below the green curve, the LV shape became more spherical in systole which is abnormal. 46 SIEMENS Healthineers syngo VVI analysis SIEMENS ..... Healthineers ... Average MyDGCS -14.32 % MyBGLS 15 -15.5 23.595 % EndoGCs -23.55 % 05 % EF 54.75 % Constant-Shape contraction EDV 111.39 ml 10 ESV 50.33 ml 2.79 43.84 6.55 cm -15 ESDbas EDL 3.04 cm 7.86 cm -20 4.08 cm EdLVmass 79.16 EsLVmass 98.04 -25 SD-TS-Syst. 29.0 SD-LS-Syst. 5.1 -30 -35 GLS EF TTTTTT 10203040506070 HC US MSC S SET 47 Unrestricted © Siemens Healthineers 2022 Speaker Notes In this example, the EF and GLS are both normal. The shape function is also normal which is indicated by the result being plotted above the green curve. The shape function volume graphic also appears normal. Note: When an endo-epi trace is performed, the MyoGLS number is used for graph results. When just an endocardial trace is performed, the EndoGLS number is used. 47 SIEMENS Healthineers Perform GCS SIEMENS ..... Healthineers ... • If EF is normal, but GLS 32 M is decreased, GCS should be performed 24.64 Averig 41.00 00 • GCS should be elevated 3.20 1.60 in this scenario 0.00 Circumferential Strain [lyon 's 2.40 3.20 • GCS can compensate for day IDA 11.52 . Peal GLS, which keeps the EF GRS 17.67 13.8 19.4 122.6 within normal range Syst. Myo Circumferential Strain% Syst. Radial Strain 48 Unrestricted © Siemens Healthineers 2022 Speaker Notes If EF is normal and GLS is truly reduced, GCS should be elevated. The reason for this is that the circumferential torsion of the heart is compensating for the lack of longitudinal shortening. If GCS is not elevated, one should consider that the original GLS contour and analysis may be incorrect. 48 SIEMENS Healthineers Global circumferential strain (GCS) SIEMENS ..... Healthineers ... 1. 2D clip with 4. Global contour circumferential 1 4 strain curve 2. End-systolic Rotation of border and end- SUM MUM 5. 5 endocardial layer diastolic border Circumferential Strain [Myo) Ss 2 3 17.67 6 6. Bull’s eye results -19.4 3. Analysis results rential Strain% for the displayed clip Syst. Myo Cir Syst. Radial Strain% HC US MSC S SET 49 49 Unrestricted © Siemens Healthineers 2022 Speaker Notes In this example, the parasternal short axis at the level of the papillary muscle (PSAX PM) has been analyzed. The quantitative data derived from the velocity are depicted as parametric curve graphs, M- mode graphs and segmental diagrams. The results displayed are dependent on the view used to draw the contour. For example, if the apical view, short axis view, atrium view, or RV view are analyzed, the user can select the desired parameter (Velocity, Displacement, Strain, or Strain Rate). 49 SIEMENS Healthineers syngo VVI analysis SIEMENS ..... Healthineers ... Segmental analysis • Quantitative results from syngo VVI are represented as 14-apical septal H0 101 15-apical balard parametric curve graphs, M- 113 Average Maslevure Opposing Wall Delay : 345 ms mode graphs, and segmental Average E3 Sty1/85 052/0000/2811 ms (64 Rrvere Peak diagrams Radial Long/Rot 64Phase-bo • Results are dependent on the view used to draw the contour ES TIP AS Psugt 21.2 274 14-apical septal 430 16-apical lateral and the parameter selected Average 221 22 9 Mineurs Opposing Wall Delay : 69 ms es gis endo 23 02 % wa gls myo -41.37 % es ges endo 27.42 % such as velocity, displacement, strain or strain rate 50 Unrestricted © Siemens Healthineers 2022 Speaker Notes The syngo VVI segmental analysis includes quantitative data derived from curve graphs, M- mode graphs, and segmental diagrams. The user has the ability to obtain results depending on the desired contour and parameter selected such as velocity, displacement, strain and strain rate. 50 SIEMENS Healthineers Global longitudinal strain (GLS) SIEMENS ..... Healthineers ... Segmental analysis 1. Radial or 4 4. Displays velocity, Strain Rows transverse displacement, 361 14 apical septal 15-apical 23. segmental strain -banal antilal strain, strain rate Average Maslevure Opposing Wall Delay : 345 ms data 1 Average E3 Sry/85 052/0000/2011 ma (64] Rovine Peak 5 Radial 5. Radial or Long/Rot 2. Contour analyzed 2 transverse 467 m segmental timing Longitudinal Strain jeado) Seg PK % ES TIPPS curves 0-mit Indisegt 14-apical septal 430 3. Longitudinal or me To Pea 16-apical lateral 430 6 Average 221 229 circumferential Manimsure Opposing Wall Delay : 69 ms 6. Longitudinal es gis endo 23 02 % wegls myo 47.37 % es ges mdo 27.42 % segmental data segmental timing 3 curves HC US MSC S SET 51 51 Unrestricted © Siemens Healthineers 2022 Speaker Notes The segmental analysis page for GLS displays peak and timing information. Analysis values can be displayed for velocity, displacement, strain, and strain rate. This page enables the user to view segmental curve and analysis results for the activated contour model. The analysis page displays the clip with the contour for the selected view, segment diagrams with time-to-peak and phase results, and curve graphs for the selected segments. The curve graphs display results for the activated segments in the segmental model. Segments may be removed from the segmental display and the Average value will reflect the edit. The es-gls and es-gcs global values in the bottom left of the display do not change when segments are removed. 51 SIEMENS Healthineers Global circumferential strain (GCS) SIEMENS ..... Healthineers ... Segmental analysis 1. Radial strain 4. Displays for velocity, . Velocity Displacement . Strain Rat 4 data Seg Pk % ES TTP ms displacement, 07-mid ant 26.9 26.9 227 27.6 27.6 227 co Radial Swain 53.00- 42.5 41.6 255 00 mld inf 49.6 46.9 269 strain, and strain 23.6 23.4 241 OB-mid antisept 22.7 22.7 Average 31.5 31.5 227 226 5 Maximum Wall Delay :42 ms 1 rate Average DJ 2. Contour Reverse Peak Radial -50 Phase +50 analyzed LangFiat 5. Radial strain 434 m2 2 22 segmental timing curves Circunferertial Strain (undo) Circumferential Strain (endo ) Seg PK % ES TTP ms 07-mid ant 45.0 44.0 258 12-mid antrat -33.2 -31.3 170 3. Circumferential 11-mid inthat -43.1 41.7 -44.1 -43.5 266 10-mid int 241 6 09-mid int/sept -38.9 -34.4 340 08-mid antisept -43.5 -39.9 Circumferential 269 data 6. Average -J9.6 39.1 240 Maximum Wall Delay :170 ms segmental timing es-rot myo -3.19 deg 3 es-gcs endo -18.09 % es-gcs myo -26.62 % -50 Phase +50 434 434 m245% curves -10 HC US MSC S SET 52 Unrestricted © Siemens Healthineers 2022 Speaker Notes The segmental analysis page for GCS displays peak and timing information. Analysis values can be displayed for velocity, displacement, strain, and strain rate. In the segmental analysis page for the GCS, the quantitative data derived includes radial and circumferential data, controls for velocity, displacement, strain and strain rate. Additionally, when the endocardial and epicardial borders are analyzed, the complete bull’s eye map and circumferential graphs are displayed. 52 SIEMENS Healthineers Exporting images SIEMENS Healthineers ... To export an image: • Choose required clip Export Export • To change clip frame, use CINE Image Data control Export Save to • Select Export Image from the Clip Report left side of the monitor • Select available media Note: A DICOM video clip cannot be exported 53 Unrestricted © Siemens Healthineers 2022 Speaker Notes Images can be exported to an external USB-compatible storage device or a network location. Exported image files contain the display window without the on-screen selection. To export an image: • Select the desired clip (to change the clip frame, use the CINE control) • Select Export Image • Select available media Note: A DICOM video clip cannot be saved/exported. 53 SIEMENS Healthineers Exporting clips SIEMENS Healthineers ... To export a clip: • Choose required clip Export Export • Select Export Clip Image Data • Select available media Export Save to Clip Report Note: A DICOM video clip cannot be exported 54 Unrestricted © Siemens Healthineers 2022 Speaker Notes Exported clip files contain the clip in motion, as displayed within the clip window. To export a clip: • Select the desired clip • Select Export Clip • Select available media Note: A DICOM video clip cannot be saved/exported. 54 SIEMENS Healthineers Exporting images and clips SIEMENS Healthineers ... To export data as TXT and XML files: Export Export • Select view to display Image Data analysis for export • Select Export Data Export Save to Clip Report • Select available media 55 Unrestricted © Siemens Healthineers 2022 Speaker Notes Exported data files save as TXT and a XML files. The analyzed data for the selected view displayed can be quickly exported for off system analysis and review. The specific results displayed on the analysis screen and exported to the worksheets and report depend on the defined contour, the selected views and the selected display parameters, for example; velocity, displacement, strain and strain rate. To export data as TXT and XML files: • Have the desired analysis results page on the monitor • Select Export Data • Select available media 55 SIEMENS Healthineers Saving analysis results or image to report SIEMENS Healthineers ... To save data to a report Velocity Vector Imaging Label Value Method Left Ventricle V2 V3 V4 V5 A4C, A2C, A3C EDV 114.65ml 99.87 99.87 107.70 114.65 114.65 ESV 46.40ml Last 30 10 39.10 46.31 46.40 Export 46.40 Image Export EF Data 39.33% Last 00.58 27.02 EndoGLS -22.83% Last -23.58 -23.58 21.80 -22.83 22.83 SD-Ttp-LS 3.02% Last 2.90 2.90 3.55 3.02 Export Save to A2C EDV 131.44ml Clip Report Last 109.60 109.60 141.50 131.44 131.44 ESV 51.68ml Last 37.23 37.23 ONDS 01.00 51.68 EF 60.68% Last 66.03 66.03 57.00 60.68 60.68 EndoGLS -22.36% Last -27.99 -27.99 22.28 -22.36 -22.36 A3C EDV 103.45 m Last 93.82 93.82 85.88 103.45 103.45 Note: Although bookmarks are saved, the ESV 48.91ml Last 39.04 39.04 20.31 76.91 48.91 EF 52.72% Last 58.38 58.38 57.49 52.72 52.72 report lists analysis results individually EndoGLS -21.35% Last -20.01 -20.01 20.52 -21.35 A4C EDV 109.07 m 96.19 96.19 95.71 109.07 109.07 Print Preview Export PDF Print Report 56 Unrestricted © Siemens Healthineers 2022 Speaker Notes The user can export strain analysis results to the patient report. Once all desired views are analyzed, select Save to Report on the touch screen. The results will be saved under the Velocity Vector Imaging section of the report. The specific results exported to the report worksheet depend on the views analyzed and the parameters selected, for example, velocity, displacement, strain and strain rate. Results are listed for average value (GLS) and by view. 56 SIEMENS Healthineers Key workflow reminders SIEMENS Healthineers .... • Set Compression rate to Low under Clip Store settings in configuration • GLS calculation is compliant with taskforce guidelines • Same syngo VVI software version as ACUSON Sequoia, ACUSON Redwood, and ACUSON Juniper ultrasound systems, providing harmony across systems • A dynamic clip capture of VVI package analysis results cannot be performed; a static clip can be acquired 57 Unrestricted © Siemens Healthineers 2022 Speaker Notes The slide above lists some points to be mindful of when using syngo VVI on the ACUSON P500 ultrasound system. 57 SIEMENS Healthineers Summary SIEMENS Healthineers ... • Review cardiac strain principles and relevance • Explain image acquisition for cardiac strain • Discuss syngo VVI workflow • Evaluate cardiac strain analysis SIEMENS 58 Unrestricted © Siemens Healthineers 2022 Speaker Notes 58 SIEMENS Healthineers Thank you for your enthusiasm! SIEMENS Healthineers .... Questions? 59 HOOD05162003262187 Unrestricted © Siemens Healthineers 2022 Speaker Notes Questions? 59 SIEMENS Healthineers Global longitudinal strain (GLS) analysis SIEMENS ..... Healthineers ... Apical 4 chamber 1. 2D Clip with Global Contour 038/65 . 034/1223/2611 ms. (64 bpm). .... 4. longitudinal / 1 circumferential 4 Endo+Epi 2. End-systolic strain curves border and S D end-diastolic MMade Change in LV 5 M 5. border shell -Contour Sy DX volumes over Segmental Analysis N time 3. Graph display 2 WE Average 3 between LVEF, 6. Bull’s eye 6 GLS and shape results function analysis GLS vontenue) adeus.quelsuo2. 1020304050607 Syst. Endo Longitudinal Strain 36 - 20 % 36 60 Unrestricted © Siemens Healthineers 2022 Speaker Notes When a contour is processed, the quantitative data is derived. Here we see the apical 4 chamber view has been analyzed and the bull’s eye map is starting to fill in. 60