Speckle-Tracking-Echokardiografie – ein neues Tool für die Intensivstation?

Zusammenfassung

Die Beurteilung der kardialen Funktion kritisch kranker Patienten ist eine wichtige diagnostische Maßnahme auf Intensivstationen. Jedoch kann die meist angewandte detaillierte echokardiografische Untersuchung gerade Ungeübte rasch an ihre Grenzen bringen. Zusätzliche Informationen vermag die myokardiale Deformationsanalyse mittels Speckle-Tracking-Echokardiografie zu liefern – ein innovatives Verfahren, das in diesem Beitrag vorgestellt wird.

Abstract

The noninvasive evaluation of cardiac morphology and function by echocardiography is an essential part of modern intensive care therapy. However, this procedure can be challenging and beginners often lack the ability to objectively state the correct global and regional myocardial function. Recent developments allow a semi-automatic deformation (strain) analysis by a couple of more objective respective parametric techniques. Strain describes the change in length of a myocardial segment during the cardiac cycle. While this is primarily a regional analysis, an insight into the global left ventricular deformation is possible by averaging all relevant segments. Speckle tracking echocardiography (STE) is actually the only clinically relevant technique and is well scientifically and clinically approved. The advantages of STE are the angle-independency, the ease and fastness of its use, the availability at the bedside and low costs. Through proven good reproducibility it should be a good method for repeated analysis even by different echocardiographers. However, actually the greatest disadvantage is the variation of measures between different vendors of ultrasound machines and software-packages. At the moment, a task force of leading echocardiography experts and industry personal is working on a solution. Normal values have been published for healthy collectives and STE has been in use in the majority of cardiac diseases. Besides from a few research studies, the usage in critically ill patients actually is still limited.

Kernaussagen

• Strain ist ein Index der myokardialen Deformation, der die prozentuale Längenänderung eines bestimmten Segmentes während des kardialen Zyklus beschreibt.

• Während die Strain-Messung grundsätzlich ein regionales Messverfahren ist, dient der Durchschnittswert mehrerer zusammengefasster Segmente als Surrogatparameter für die globale linksventrikuläre Deformation.

• Strain-Messungen können mit verschiedenen Methoden durchgeführt werden, wobei für Intensivpatienten nur die Speckle-Tracking-Echokardiografie (STE) von klinischer Bedeutung ist.

• Die grundsätzlichen Vorteile der STE sind die Winkelunabhängigkeit, die vergleichsweise Einfachheit und Schnelligkeit der Methode, die Verfügbarkeit am Patientenbett sowie niedrige Kosten. Es ist ein gut reproduzierbares Verfahren, womit es sich zur Verlaufskontrolle auch bei wechselnden Untersuchern eignet.

• Problematisch sind die Variationen der Messergebnisse zwischen verschiedenen Geräteherstellern, Softwarepaketen und -versionen. Aktuell wird an einer Lösung dieses Problems und einer Standardisierung gearbeitet.

• Normwerte für gesunde Kollektive liegen vor. Die STE kommt bereits bei einer großen Bandbreite von kardiologischen Krankheitsbildern (z. B. Amyloidose, Kardiomyopathien) zum Einsatz. Intensivmedizinische Erkenntnisse sind jedoch noch rar und erfordern weitere klinische Studien.

Schlüsselwörter

Speckle-Tracking-Echokardiografie - Deformationsanalyse - kritisch krank - Intensivstation

Key words

speckle tracking echocardiography - deformation analysis - critical ill - intensive care unit

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