ACUSON Maple 1.0 syngo VVI Presentation

SIEMENS Healthineers SIEMENS Healthineers ACUSON Maple Ultrasound System syngo Velocity Vector Imaging Technology 1.0 Software Release 1 Unrestricted © Siemens Healthineers 2023 Unrestricted Speaker Notes: The purpose of this presentation is to provide instructions on the use of syngo® Velocity Vector Imaging™ Technology with the ACUSON Maple ultrasound system. Notes No. 1 SIEMENS Healthineers Objectives SIEMENS Healthineers .... • Review cardiac strain principles and relevance • Explain image acquisition for cardiac strain • Discuss syngo® Velocity Vector Imaging™ technology workflow • Evaluate cardiac strain analysis 2 Unrestricted © Siemens Healthineers 2023 Speaker Notes: We will begin with a brief review of cardiac strain principles and their relevance in echocardiography. 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) 1 • Expressed as percentage (%) Lo Strain (€) = 𝐿1 − 𝐿0 • 𝐿0 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 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) • Global Longitudinal Strain (GLS) radial circumferential longitudinal 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 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 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/sec) • Strain: Describes myocardial deformation, or the fractional change in length of a myocardial segment (%) • Strain Rate: Rate of change in strain, expressed as 1/sec or sec-1 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/sec) • 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 With syngo VVI, 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 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 adverse cardiovascular outcomes d IPGMER, SSKM, Kolkata, India 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 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 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 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 Source: 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 or acute 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. Source: Ashish, Kumar, et al., IJC Heart & Vasculature (2019) 22: 48-49 Notes No. 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 7 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Let’s continue with a brief review of cardiac strain principles and their relevance in echocardiography. Notes No. 7 SIEMENS Healthineers syngo VVI SIEMENS ..... Healthineers ... • syngo VVI is a clinical software application used to P4-2 Adult Echo visualize, measure and assess myocardial motion Tx Power 100% AP MI 1.50 Adult Eche Ty Pawar 10 TIS 0.7 and mechanics using acquired 2D clips TIB 2.6 THI F 3.6 MHZ O dB Tracks and estimates tissue velocity and 0 bpm • deformation along a user-defined outline (contour) of the myocardium HC US MSC S Set 8 Unrestricted© Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 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. Notes No. 8 SIEMENS Healthineers Cardiac strain acquisition configuration SIEMENS Healthineers ... Acquisition Rate (frame rate) 1. Select System Configuration on the A Configuration Touch Screen ? General 1 General 2 Display Custom Keys Soft Keys Exam 2. Select Clip Store 1 Measurement Text Annotation Body Mark Stress Ech eSieScan 2 Clip Store 3. Under Acquisition Rate, select High (60Hz) Printer Barcode Wireless Network Utility Archive Security Service Close Clip Store R-wave only R-wave delay 0 Printer Barcode Acquisition Rate Wireless Normal (30Hz) 3 High (60Hz) 9 9 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Before beginning a cardiac strain acquisition for syngo VVI analysis on the ACUSON Maple™ ultrasound system, the Acquisition Rate must be set to High. The reason for this is cardiac strain clip captures must have frame rates higher than 30 frames per second (fps). The system’s factory default setting, an Acquisition Rate of Normal, limits the clip capture rate to 30 frames per second. An Acquisition Rate of High (60Hz) enables a clip capture rate of 60 frames per second. From the Touch Screen: 1. Select System Configuration 2. Select Clip Store under the System Configuration menu options 3. Under Acquisition Rate, select High (60Hz) Notes No. 9 SIEMENS Healthineers Cardiac strain acquisition “on the fly” SIEMENS Healthineers' . Acquisition Rate (frame rate) 1. Select Clip Settings A P4-2 Add Exam Workflow Adult Echo 2. Press Acquisition Rate until 60Hz is shown ? 2D Stress Echo eSiescan (enables clip capture of 60 fps) LVO Contrast THI Split Mide Physio Settings >> 1 Clip Settings DTI DICE Med RIS Tint 11 Image Size 2| Tx Power MultiHertz 3.7 MHZ Dyn R 60 dB Map TEQ Gain Capture T 2 Acquisition Rate Screen 60Hz Beat Time Beat R-Wave Image Clip Settings 10 10 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The clip store Acquisition Rate setting may also be adjusted “on the fly” during an active exam. From the Touch Screen: 1. Select Clip Settings 2. Press Acquisition Rate until 60Hz is shown (this enables a clip capture rate of 60 frames per second) Please note: After the active exam is ended, any Clip Settings that were altered “on the fly” will not be applied to default Settings in System Configuration. Notes No. 10 SIEMENS Healthineers Cardiac strain image acquisition SIEMENS ..... Healthineers ... • Ensure entire area of interest is maintained in field of view (FOV) • Optimize 2D image Settings • A full R-R wave must be contained in dataSet for quality analysis • Clips should not exceed 10 heart cycles or 10 seconds 19 cm HC US MSC S Set 11 Unrestricted© Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 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. Notes No. 11 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 allowed • Limited to 700 frames • Recommended clips should contain 6 frames minimum to 700 frames maximum 19 cm 12 Unrestricted© Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 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. Notes No. 12 SIEMENS Healthineers Cardiac strain image acquisition SIEMENS ..... Healthineers ... • 60-90 frames per second (fps) is ideal for optimal tracking results • 40 fps is the minimum frame rate and 150 is the maximum frame rate 40-80 fps are widely used in clinical literature3 28.4 • 70 – 90 frame rate range is recommended for optimal tracking results 40 frames per second is the minimum frame rate 150 frames per second is the maximum frame rate Source: Voigt, Jens-Uwe, et al., J Am Soc Echocardiography (2015) 28: 183-193 HC US MSC S Set 13 Unrestricted© Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 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 under-sampling. Please note: Frame rate is commensurate to the patient’s heart rate. Higher heart rates should have higher frame rates. Notes No. 13 SIEMENS Healthineers Global longitudinal strain (GLS) acquisition SIEMENS ..... Healthineers ... P4-2 P4-2 Adult Echo Adult Echo Adult Echo Tx Power 98% Tx Power 985% Tx Power 90% M 1.05 M 0,96 MI 0.96 FIS 0.2 TIS 0.7 EIS 0.7 TIB 0.7 118 0.7 OTCE High OTCE High DICE High Dyn R 65 dil Dyn R 05 dB Dyn R 6s en TH 4.0 MHZ THE 4.0 MHZ 49 fps 37 fps Apical 4 Chamber Apical 2 Chamber Apical 3 Chamber 14 14 Unrestricted © Siemens Healthineers 2023 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. Notes No. 14 SIEMENS Healthineers Global circumferential strain (GCS) acquisition SIEMENS ..... Healthineers ... P4-2 P4-2 P4-2 Adult Echo Adult Echo Adult Echo Tx Power 100% Tx Power 100% Tx Power 100% MI 1.50 MI 1.50 MI 1.50 TIS 0.7 TIS 0.7 TIS 0.7 TIB 2.6 TIB 2.6 TIB 2.6 THI F 3.6 MHZ THI F 3.6 MHZ THI F 3.6 MHZ 0 dB O dB 0 dB 0 bpm 0 bpm 0 bpm PSAX MV PSAX PM PSAX APEX 15 15 Unrestricted © Siemens Healthineers 2023 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. Notes No. 15 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 16 Unrestricted © Siemens Healthineers 2023 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. Notes No. 16 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 17 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Let’s discuss a brief overview of cardiac strain principles and their relevance in echocardiography. Notes No. 17 SIEMENS Healthineers syngo VVI workflow SIEMENS Healthineers ... 1. Press Review on left side of the A Patient Browser Review Control Panel and select desired General Review images Patient Select all Deselect Al 1 x1 1X2 2x2 2. Select Show Selected 4x4 Sx'S 2 Exam Show Selected Slide Show 3x3 3. Select syngo VVI Teaching File Export 1 Sermon Review Delete 3 syngo WI 11 Save Reset Marker Report DICOM Print Cine Speed Color Cine Frame Cine Start Marker Cine End Marker 90 HC US MSC S Set 18 Unrestricted © Siemens Healthineers 2023 Speaker Notes: To select clips for syngo VVI analysis, the user must first select Review from the Control Panel to choose single or multiple 2D clips. Select all images needed for the syngo 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 syngo 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. Please note: Multiple images for analysis can be selected, but only one view can be processed at a time. Notes No. 18 SIEMENS Healthineers syngo VVI workflow SIEMENS ..... Healthineers ... • For Global Longitudinal Strain (GLS) select A4C, A2C and A3C images • Chosen clips will be outlined in white HC US MSC S Set 19 Unrestricted© Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 Speaker Notes: After choosing images and selecting Show Selected, the user is able to confirm the thumbnails. For global longitudinal strain (GLS), select apical 4 chamber (A4C), apical 2 chamber (A2C) and apical 3 chamber (A3C) views. Notes No. 19 SIEMENS Healthineers syngo VVI workflow SIEMENS ..... Healthineers ... • For Global Circumferential Strain (GCS) PSAX MV, PSAX PM and APEX images • Chosen clips will be outlined in white HC US MSC S Set 20 Unrestricted© Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 Speaker Notes: After choosing images and selecting Show Selected, the user is able to 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). Notes No. 20 SIEMENS Healthineers syngo VVI workflow SIEMENS ..... Healthineers ... Assign thumbnail images accordingly • Select the Set key to place images • To delete an image, select the X in upper right of image in thumbnail image box • Select the gray arrow displayed in lower right corner of screen to proceed SAX APEX O HC US MSC S Set 21 Unrestricted © Siemens Healthineers 2023 Unrestricted© Siemens Healthineers 2023 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, select the Set key to choose a thumbnail image (note that this is not a click and drag action) • In the lower right corner of the screen, assign the thumbnail image to the corresponding view by selecting 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. Notes No. 21 SIEMENS Healthineers syngo VVI SIEMENS Healthineers ... syngo VVI supports strain analysis on the following Apical X Sax Atrium views: 1. Apical A4C SAX MV Atrium • Complete apical analysis provides full X bull’s eye map 2. Short axis (SAX) Complete short axis analysis provides full A2C SAX PM • bull’s eye map RV 3. Left atrium (Atrium) RV 4. Right ventricle (RV) A3C SAX APEX O 22 22 Unrestricted © Siemens Healthineers 2023 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 three 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 three 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 Notes No. 22 SIEMENS Healthineers Gamma slider gain control (dB) SIEMENS ..... Healthineers ... -Settings- -.- Endo+Epi X -MMode -Contour If necessary, to modify the gain Setting, click and drag the Gamma slider to the right or left to adjust the overall gain -Segmental Analysis- 23 23 Unrestricted© Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 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. Notes No. 23 SIEMENS Healthineers syngo VVI workflow SIEMENS ..... Healthineers ... Three-point method • Identify placement guide for positioning 3.(0) contour markers • See trackball controls for positioning contour markers • Press the Set key to place first and second markers at annuli • Press Update key to “End” trace at the apex End Set Set 24 Unrestricted © Siemens Healthineers 2023 Unrestricted© Siemens Healthineers 2023 Speaker Notes: To draw a three-point method contour in the apical 4 chamber view: • The syngo 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 • Place the next marker at the basal lateral region • Place the last marker in the apical region. • Double-click either Set key or click the Start Analysis icon • 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, double-click either Set key or click the Start Analysis icon under the Contour section to proceed to the analysis page Please note: The placement guide on the bottom right-hand corner of the monitor demonstrates which trackball controls to use and in which order to place the markers for the three-point method. Notes No. 24 SIEMENS Healthineers syngo VVI workflow SIEMENS ..... Healthineers ... Manual trace method • Using the Set key, place markers in a clockwise pattern starting at basal septum • To complete the trace, press the Update key to anchor • To process trace, double-click the Set key or select the Start Analysis icon for systole and then diastole Delete/Calculate Set Set TIP Recommended are at least 7-11 markers for apical traces 25 Unrestricted © Siemens Healthineers 2023 Unrestricted© Siemens Healthineers 2023 Speaker Notes: To create a manual trace: • The syngo 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 the 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 Start Analysis icon under the Contour area in control Settings • The syngo 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 Start Analysis icon under the Contour section to proceed to the analysis page Notes No. 25 SIEMENS Healthineers syngo VVI workflow SIEMENS ..... Healthineers ... Performing endocardial and epicardial trace 1. Select Endo+Epi box 2. Select green arrows on right side of image to increase or decrease the thickness 1 between endocardial and epicardial traces 3. To process trace, double-click the Set key or select Start Analysis icon for systole and then diastole 2 3 3 19 cm Delete/Calculate Set Set 26 Unrestricted© Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 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. Select 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 click the Start Analysis icon under the Contour area for the systolic trace and then the diastolic trace Notes No. 26 SIEMENS Healthineers syngo VVI workflow SIEMENS ..... Healthineers ... Edit marker placement Edit the desired marker using Set key to drag and reposition: • Red markers adjust a larger portion of the Endo El contour • Blue markers adjust a smaller portion of the contour Segmental Analysis Delete/Calculate Set Set 27 Unrestricted© Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 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. Notes No. 27 SIEMENS Healthineers syngo VVI workflow SIEMENS ..... Healthineers ... Delete a contour 987/50 033/2700/3000 m (35 5pm) 1. Select X next to view 2. Select OK -Settings EndatEpi S D Delete Selected Contour 385.00 Confirm ? 276.40 207.60 123.40 69.20 Segnontal Analyse -120.40 Longhidinal Strain (Finden -207.60 376.30 345.00 2 -15.0 a 4c X 1 Syst. Endo Longitudinal Strain 28 Unrestricted© Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 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. Please note: If a new contour is drawn without deleting the previous contour, the results will be averaged and therefore inaccurate. Notes No. 28 SIEMENS Healthineers syngo VVI workflow SIEMENS ..... Healthineers ... Modify cardiac timing markers Select Sequence/M-mode icon under MMode in 29.00 EndoGLS control Settings: 23.20 EndoGCS 17.40 ED marker should align with peak on 11.60 -Settings- • 5.80 red Volume curve 0.00 • ES marker should align with trough on 5.80 red Volume curve 11.60 Endo+Epi 17.40 • Note that any curve on graphs can be -23.20 hidden by toggling its colored box 1125 S DI -29.00 ms 375 750 1500: 1875 2250 2625 180.00 Volume dV/dt 567.00 168.70 453.60 -MMode - 157.40 340.20 146.10 226.80 134.80 113.40 Contour CHIS DX 123.50 eD. 0.00 112.20 1125 1500 -113.40 -Segmental Analysis- 100.90 226.80 89.60 -340.20 78.30 453.60 % 67.00 % ms 375 750 1125 1500; 1875 2250 -567.00 ml ml/s 262 *continued on next slide 29 Unrestricted© Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 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 Please note: Any curve on the graphs can be hidden by selecting the corresponding curve’s color box next to the graph. Notes No. 29 SIEMENS Healthineers syngo VVI workflow SIEMENS ..... Healthineers ... Modify cardiac timing markers referencing Cine 2D clip • Select Freeze for the 2D reference image • Press the Set key to select and drag ED then the ES red bar to desired location A4C • Watch the Cine behavior of the 2D image to align marker placement Reverse X • Press the arrow in the top right corner to proceed 3% Bpm Period Selo 30 Unrestricted © Siemens Healthineers 2023 Unrestricted© Siemens Healthineers 2023 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 and then 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 and then 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, which will take you back to the analysis page with updated results for the new marker placement. Notes No. 30 SIEMENS Healthineers syngo VVI workflow SIEMENS ..... Healthineers ... Modify cardiac timing markers referencing M-mode display • Select Freeze to stop the 2D reference image • Press Set on the 2D clip to enable drawing A4C the M-line • Press Set key to select and drag ED then Reverse EX the ES red bar to desired location 52 0pm 136.7 • Press the arrow in the top right corner to proceed Reset Period Selector 31 Unrestricted © Siemens Healthineers 2023 Unrestricted© Siemens Healthineers 2023 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 and 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 and then 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 and then 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 which will take you back to the analysis page with updated results for the new marker placement. Notes No. 31 SIEMENS Healthineers syngo VVI workflow SIEMENS ..... Healthineers ... Toggle the M-mode display off/on curve graph analysis • When the M-mode display is used -Settings for editing cardiac timing markers, the M-mode display also appears on curve graph analysis Endo+Epi X • To toggle M-mode display off of Average curve graphs, select the Bkg MMode display icon MMode Leegitudinal Strain (Myel Contour Average MyuGES -26.17 CHIS Dy ml Av EndoGIS -22.97 EF 66.32 Segmental Analysis- EDV 108 37 -24.9 ESV GRS 20.60 ESI 6.64 Cm 17.8 27.1 ESDbas 2.89 cm FOI -22.2 EDObas EIES 3.97 cm SD TS Syst. 23.8 20 6 SD-LS-Syst. 10.1 52.2 15.0 Syst. Transverse Strain% Syst. Myo Longitudinal Strain% 32 Unrestricted© Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 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 the Bkg MMode display icon in control Settings. Please note: This icon only appears when the M-mode drawing tool is used for reference in modifying cardiac timing. Notes No. 32 SIEMENS Healthineers syngo VVI workflow SIEMENS ..... Healthineers ... Modify cardiac timing markers To analyze a clip without an ECG or with a poor ECG: • Set R-R interval using the Set key to select and drag R1, then R2 blue bar markers A4C • Press the Set key to select and drag ED and ES red bar markers to desired location • Press the arrow in the top right corner to proceed Current selection does not include a minimum of one heart cycle, please set R-waves. Ported Selotty HC US MSC S Set 33 Unrestricted © Siemens Healthineers 2023 Unrestricted© Siemens Healthineers 2023 Speaker Notes: Although using a stored clip without an ECG is permitted, 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 then click 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 and 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 and 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 Notes No. 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 34 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Lastly, we will discuss how to evaluate a cardiac strain analysis. Notes No. 34 SIEMENS Healthineers syngo VVI workflow SIEMENS Healthineers .... -Settings Gamma Slider Endo+Epi X Endo+Epi Zoom In/Out Go to End Systole or S D Pictures Mirroring End Diastole Contours or Vectors Sequence/M-mode MMode Selection - Bkg MMode display Contour New Trace -Segmental Analysis- Correct ES Border Segmental Analysis Correct ED Border Swap 3D/2D Border 35 35 Unrestricted © Siemens Healthineers 2023 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, the end diastolic (ED) marker and end systolic (ES) marker Bkg MMode 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) Notes No. 35 SIEMENS Healthineers Global longitudinal strain (GLS) analysis SIEMENS ..... Healthineers ... Apical 4 chamber 1. 2D Clip with 4. Global Contour longitudinal/ 1 circumferential 2. End-systolic 4 strain curves border and end- S D diastolic border MNode 5. Change in LV shell volumes over 5 31.40 -Sogmental Analyst time 744.30 3. Graph display .325 60 between LVEF, 6. Bull’s eye results GLS and shape 2 3 6 function analysis Syst. Myo Longitudinal Strain% 36 36 Unrestricted © Siemens Healthineers 2023 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. Notes No. 36 SIEMENS Healthineers Global longitudinal strain (GLS) analysis SIEMENS ..... Healthineers ... Apical 2 chamber 1. 2D Clip with 4. Global 29.64 Contour 22.20 longitudinal/ 14.30 1 D.M circumferential 2. End-systolic 14.34 4 22.20 strain curves -25.60 border and end- 37. MED S D 113.54 378.00 diastolic border 246.00 -Mode 5. Change in LV 148.00 shell Contour volumes over 5 74.10 -Sognental Analyst 61.20 .1.51.00 time 53.14 277.00 3. Graph display 46.48 295.00 MYGCS -21.26 % mi Average mi'sAverage MyoGLS -19.61 between LVEF, EndeGCs 23.43 Peak FadoGLS -22.64 6. Bull’s eye results 2 3 60.32 EDV 102.36 ml GLS and shape 6 ESV 41.10 ml 681 on Ix 15Dbes function analysis 8.51 on EDDbas 1.61 cm 50-15-515L. SD-AS-Syst. 62 areg Strain 38.4 Syst. Myo Longitudinal Strain% 37 37 Unrestricted © Siemens Healthineers 2023 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. Notes No. 37 SIEMENS Healthineers Global longitudinal strain (GLS) analysis SIEMENS ..... Healthineers ... Apical 3 chamber 1. 2D Clip with 4. Global Contour longitudinal/ 1 circumferential 2. End-systolic 4 strain curves border and end- S D 351.00 diastolic border 210.200 MMode 5. Change in LV 218.60 148.40 shell 78.20 Contour volumes over 70.20 5 -Sognental Analyse time .383.40 710.ED 3. Graph display -230.80 2D MYaGCS -27.00 5351.00 30 mi Average mi'sAverage MyoGLS -22.13 2475 between LVEF, 2 EndeGCs -34.81 FadoGls -24.54 Bull’s eye results 3 6. EDV 103 29 GLS and shape 6 function analysis FDObas 50-15-5ysL. SD-4S-Syst. Syst. Myo Longitudinal Strain% Syst. Transverse Strain 38 38 Unrestricted © Siemens Healthineers 2023 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). Notes No. 38 SIEMENS Healthineers syngo VVI workflow SIEMENS ..... Healthineers ... If necessary, toggle between the -Settings contour’s border, vector, trajectory or B-mode icons Endo+Epi X 29.8 al Analysis- 19 cm Longitudinal Strain (Myo) % HC US MSC S Set 39 Unrestricted© Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 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. Notes No. 39 SIEMENS Healthineers Global longitudinal strain (GLS) analysis SIEMENS ..... Healthineers ... Bull’s eye map 1. Bull’s eye map for Average MyoGCS -22.54 % strain results MyoGLS -17.32 % EndoGCS -32.48 % Peak DES TTP% Phase EndoGLS -19.97 % 2. Numerical result for EF 62.25 % EDV 96.07 ml 1 -19.9 36.4 the segment of the ESV 36.66 ml GRS 43.39 % 2 selected parameter ESL 6.92 cm 10.3 -21.8 -7.9 54.6 35.0 59.7 ESDbas 3.71 cm 8.57 cm -14.8 18.5 49.6 EDL 14.8 26.3 67.4 3. Color bar for EDDbas 4.18 cm SD-TS-Syst. 15.4 % 18.2 01-22.6 16.5 28.7 the selected SD-LS-Syst. 5.1 % -26.6 16.2 16.8 45.5 23.2 30.8 parameter -12.9 22.7 -15.6 33.8 60.7 51.6 -10.1 26.1 Syst. Myo Longitudinal Strain% Syst. Transverse Strain% 20 20 % 68 68 % 3 HC US MSC S Set 40 Unrestricted© Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 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. Notes No. 40 SIEMENS Healthineers LV EF, GLS and shape function analysis SIEMENS Healthineers ... ...... The 3D volume Average model is a display MyoGCS -22.54 % MyoGLS -17.32 % of the shape of the -05 EndoGCS -32.48 % LV at end diastole Constant-Shape contraction EndoGLS -19.97 % EF % and end systole. 10 EDV 96.07 ml ESV 36.66 ml GRS 43.39 % 15 The graph displays .0.82 ESL 6.92 cm ESDbas 3.71 cm the relationship -20- EDL 8.57 cm EDDbas 4.18 cm between EF, GLS, SD-TS-Syst. 15.4 % -25 SD-LS-Syst. 5.1 % and the shape function of the left -30 ventricle (LV). -35 ....... ...... GLS EF 10 20 30 40 50 60 70 41 Unrestricted © Siemens Healthineers 2023 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. Notes No. 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 LOS • EF and GLS have a linear relationship, which is represented by the green line -10 -25 42 Unrestricted © Siemens Healthineers 2023 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. Notes No. 42 SIEMENS Healthineers EF and GLS relationship SIEMENS Healthineers' .... 0 • If the VVI result is plotted in the blue area, EF and GLS are both normal • If plotted in the orange area, EF and GLS are both abnormal -10 Abnormal • If result is plotted in the gray area, EF is normal and GLS is reduced, which requires ? a GCS to analyze the results GLS -20 Normal -30 0 50 100 EF 43 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The graph on this slide displays EF along the bottom (x) axis and GLS along the side (y) axis. If the VVI result is plotted in the blue area, EF and GLS are both normal. If plotted in the orange area, EF and GLS are both abnormal. 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 to clarify this is to perform GCS. Notes No. 43 SIEMENS Healthineers LV shape function SIEMENS ..... Healthineers ... • The shape of the LV plays a part in the LV function Constant-Shape contraction • The shape is represented by the green curvilinear graph -10 -15 -20 HC US MSC S Set 44 Unrestricted© Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 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. Notes No. 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.1) EF-60%, GLS-30%, SF-5%4 EF-60%, GLS -- 265%, SF-0% Saly similar EF-60%, GLS-231, SP-5%6 EF-50%6, GLS -- 19%, SP-10% Fig. 1. Example of contraction shapes with same EF and different GLS. From left to right the GLS de es with same EF and different GLS. From left to right the GLS decreases and the longitudinal function dimin I 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. 1) Pedrizzetti, Gianni, et al., Journal of Biomechanics (2014) 47.3: 746-749 45 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Research concludes 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. 1) Pedrizzetti, Gianni, et al., Journal of Biomechanics (2014) 47.3: 746-749 Notes No. 45 SIEMENS Healthineers LV shape function SIEMENS ..... Healthineers ... Above the green curve: the shape is normal Constant Shape contraction • (conical) as the LV contracts • On the green curve: no significant change in shape • Below the green curve: the LV shape became increasingly 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 2023 Unrestricted © Siemens Healthineers 2023 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 Notes No. 46 SIEMENS Healthineers syngo VVI analysis SIEMENS ..... Healthineers ... EF and GLS are normal in this example Average • MyoGCS -22.54 % MyoGLS -17.32 % • The shape function is normal – EndoGCS -32.48 % indicated by the result plotted above -05 Constant-Shape contraction EndoGLS -19.97 % the green curve EF 62.25 % -10 EDV 96.07 ml The shape function volume graphic ESV 36.66 ml • 10.82 GRS 43.39 % appears to be normal -15 ESL 6.92 cm ESDbas 3.71 cm 20- EDL 8.57 cm EDDbas 4.18 cm SD-TS-Syst. 15.4 % 25 SD-LS-Syst. 5.1 % 30- -35 GLS EF 10 20 30 40 50 60 70 HC US MSC S Set 47 Unrestricted© Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 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. Please 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. Notes No. 47 SIEMENS Healthineers Perform GCS SIEMENS ..... Healthineers ... • If the EF is normal, but the GLS is decreased, GCS should be performed • The GCS should be elevated in this scenario • The GCS can compensate for GLS, which keeps the EF within normal range nnn des 13.8 26.9 ential Strain% 08 146.9 14.0 Syst. Radial Strain Syst. Myo Cira 48 Unrestricted© Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 Speaker Notes: If the EF is normal and the GLS is truly reduced, the GCS should be elevated, which is due to the fact that the circumferential torsion of the heart is compensating for the lack of longitudinal shortening. If the GCS is not elevated, consider that the original GLS contour and analysis may be incorrect. Notes No. 48 SIEMENS Healthineers Global circumferential strain (GCS) SIEMENS ..... Healthineers ... 1. 2D clip with 4. Global circumferential contour 24.68 strain curve 1 $5.40 4.00 24.50 4 32.30 5. Rotation of 41.00 0 % Average 2. End-systolic endocardial layer 1.20 border and end- diastolic border 2.48 5 6. Bull’s eye results Swerage 4.09 20 EndoGCS 38.09 £oa carrent FDA 13.52 Peak 3 ESA 5.35 FAC 41.18 3. Analysis results GRS 17.67 Dela-not 12.13 6 SD-AS Syst. 26.9 2 SD-CS-Syst. 09.4 for the displayed 98 rential Strain% clip 18 46.9 Svet. Myo Cir Syst. Radial Strain HC US MSC S Set 49 Unrestricted© Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 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). Notes No. 49 SIEMENS Healthineers syngo VVI analysis SIEMENS ..... Healthineers ... Segmental analysis • Quantitative results from syngo VVI are represented as parametric curve graphs, . Velocity . Displacement o Serain Swain Rate PK % ES TTP ms M-mode graphs and segmental diagrams DJ-basal Inf/sept 44.6 43.4 use Sitiais 09-mid intisept 37.5 37.3 322 268 14-apical septal 39.6 37.9 375 16-apical lateral 39.0 39.0 286 12-mid antlat Results are dependent on the view used 06-basal ant/lat 27.9 27.6 268 31.6 23.7 500 • Average 34.8 34.8 286 Maximum Opposing Wall Delay : 178 ms to draw the contour and the parameter Average X selected such as velocity, displacement, 445 strain or strain rate Longitudinal Strain [ondo) Longitudinal Strain [endo ) Seg Pk % ES TTP ms 8014 DJ-basal Infisept -19.2 -18.7 09-midi intisept -21.0 -21.0 122 14-apical septal -27.6 -27.5 304 286 Time To Peak 16-apical lateral -30.1 -30.1 12-mid antlat 06-basal ant/lat -20.2 -20.1 286 928 ms 304 -19.0 -18.6 Average -22.8 -22.7 322 304 Maximum Opposing Wall Delay : 0 ms es-gls endo -22.35 % es-gls myo -20.11 % es-gcs endo -34.56 % es-gcs myo -26.84 % -50 Phase 450 467 457 mS 50 Unrestricted© Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The syngo VVI segmental analysis includes quantitative data derived from curve graphs, M- mode graphs and segmental diagrams. The user may obtain results such as velocity, displacement, strain and strain rate depending on the desired contour and parameter selected Notes No. 50 SIEMENS Healthineers Global longitudinal strain (GLS) SIEMENS ..... Healthineers ... Segmental analysis 1. Radial or 4. Displays velocity, Transverse Strain . Velocity . Displaceme . Strain Rate 4 transverse Seg Pk % ES TTP ms displacement, strain, DJ-basal Inf/sept 44.6 43.4 322 09-mid intisept 37.5 37.3 268 segmental strain 14-apical septal 39.6 37.9 375 16-apical lateral 39.0 39.0 286 strain rate 12-mid antlat 27.9 27.6 268 data 06-basal ant/lat 31.6 23.7 500 34.8 34.8 286 1 928 ms Average X 5. Radial or 2 445 2. Contour analyzed 5 -40 transverse 450 Phase +50 457 ms segmental timing gitaaral Strain fondo curves Losg tudinal Stroin [endo) 3. Longitudinal or gitudinal Strain [endo ) Pk % ES TTP ms circumferential 09-mid infisept -19.2 -18.7 -21.0 -21.0 322 304 Time To Peak 6. Longitudinal 14-apical septal -27.6 -27.6 286 16-apical lateral -30.1 -30.1 286 828 ms segmental data 12-mid antlat 06-basal ant/lat -20.2 -20.1 -19.0 -18.6 304 322 segmental timing Average -22.8 -22.7 304 Maximum Opposing Wal Delay : 0 ms 3 es-gis endo -22.35 % 34 curves es-gls myo -20.11 % es-gcs endo -34.55 % 6 es-gcs myo -26.84 % -50 Phase +50 34 467 457 MS -49 HC US MSC S Set 51 Unrestricted © Siemens Healthineers 2023 Unrestricted© Siemens Healthineers 2023 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 allows 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. Notes No. 51 SIEMENS Healthineers Global circumferential strain (GCS) SIEMENS ..... Healthineers ... Segmental analysis 1. Radial strain data 4. Displays for velocity, Radial Strain 4 Seg Pk % ES TTP ms 07-mid ant 26.9 26.9 227 displacement, strain, 12-mid antlat 27.6 27.6 227 11-mid infilat 42.5 41.6 255 10-mid inf 49.6 46.9 269 09-mid intisept 23.6 23.4 241 and strain rate OB-mid antisept 22.7 22.7 227 Average 31.5 31.5 226 5 Maximum Wall Delay 1 2. Contour analyzed 5. Radial strain Reverse Peak Radial -50 Phase +50 segmental timing 434 434 m2 LangFiat 2 curves 3. Circumferential athal Strain [mando) Circunferertial Strain (unda) data Circumferential Strain (endo ) Time To Peak Seg PK % ES TTP ms 6. Circumferential 07-mid ant 45.0 44.0 255 12-mid antilat -33.2 -31.3 170 11-mid inthat 43.1 41.7 266 10-mid inf -44.1 -43.5 241 6 segmental timing 09-mid int/sept 38.9 -34.4 340 08-mid ant/sept -43.5 -39.9 269 Average -J9.6 39.1 240 Maximum Wall Delay curves : 170 ms es-rot myo -3.19 deg 3 es-gcs endo -18.09 % es-gcs myo -26.62 % -50 Phase +50 434 434 m245% HC US MSC S Set 52 Unrestricted© Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The segmental analysis page for the 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. Notes No. 52 SIEMENS Healthineers Exporting images SIEMENS Healthineers .... To export an image: A • Choose required clip ? syngo WI • To change clip frame, select the Cine control Exit • Select Export Image • Select available media Export Image Export Data Patient Export Clip Save to Report K Cine Note: A Digital Imaging and Communications in Medicine (DICOM) video clip cannot be saved or exported 53 Unrestricted © Siemens Healthineers 2023 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 Please note: A Digital Imaging and Communications in Medicine (DICOM) video clip cannot be saved/exported. Notes No. 53 SIEMENS Healthineers Exporting clips SIEMENS Healthineers .... To export a clip: Choose required clip D • ? syngo WI • Select Export Clip Select available media Exit • Screen Export Image Export Data Export Clip Save to Report Cine Note: A DICOM video clip cannot be exported 54 Unrestricted © Siemens Healthineers 2023 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 Please note: A DICOM video clip cannot be saved/exported. Notes No. 54 SIEMENS Healthineers Exporting images and clips SIEMENS Healthineers .... To export data as TXT and XML files: Select View to display analysis for D • ? syngo VI export • Select Export Data Exit • Select available media Screen Export Image Export Data Export Clip Save to Report Cine 55 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Exported data files save as TXT and 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 Notes No. 55 SIEMENS Healthineers Saving analysis results or image to report SIEMENS Healthineers .... To save data to a report Adult Echo Exam Specific Information Velocity Vector Imaging Velocity Vector Imaging Label Method Value V1 V2 V3 V4 Left Ventricle Export Image Export Data Images A4C Comments EDV Last 144.08 ml 144.08 Export Clip Save to Report ESV Last 64.89 m 64.89 EF Last 54.96 % 54.96 EndoGLS Last -17.94 % -17.94 MyDGLS 18.48 % 18.48 To save image of report Report Results @xyz Assessment Images Comments Print Preview Close Stress Echo WMS LV Result WMS Result Summary Print Report Export PDF Store Report 56 Unrestricted © Siemens Healthineers 2023 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. A still image capture of the Velocity Vector Imaging report section can be saved by selecting Store Report. Notes No. 56 SIEMENS Healthineers Key workflow reminders SIEMENS Healthineers .... • For Acquisition Rate, ensure High is selected under Clip Store before acquiring images for strain • GLS calculation is compliant with taskforce guidelines • The syngo VVI workflow is very similar on the ACUSON Sequoia™ ultrasound system and the ACUSON Redwood™ ultrasound systems, providing harmony across systems • A dynamic clip capture of the syngo VVI package analysis results cannot be performed; a static clip can be acquired 57 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The slide above lists some points to be mindful of when using syngo VVI on the ACUSON Maple ultrasound system. Notes No. 57 SIEMENS Healthineers SIEMENS Trademarks and Disclaimers Healthineers .... ACUSON Maple, ACUSON Redwood and ACUSON Sequoia are trademarks of Siemens Medical Solutions USA, Inc. syngo® Velocity Vector Imaging™ technology is a registered trademark of Siemens Healthcare GmbH 58 Unrestricted © Siemens Healthineers 2023 Speaker Notes: No Speaker Notes. Notes No. 58 SIEMENS Healthineers Thank you for your enthusiasm! SIEMENS Healthineers .... Questions? 59 Unrestricted © Siemens Healthineers 2023 Speaker Notes: No speaker notes. Notes No. 59