Myocardial Tissue Characterization with Echocardiography in Critical Care

Characterization of tissue in echocardiography starts with visual assessment of the regular greyscale 2D imaging. However, this does not allow to examine intricate structural and functional components of the myocardium. Myocardial motion and deformation carry the wealth of information, offering new understanding of the physiology and pathophysiology of critical illness and our interventions. It brings new level of diagnostic opportunities. Qualitative and quantitative assessment of cardiac tissue became possible with the developments in tissue Doppler applications and speckle tracking technologies. Both techniques are now incorporated in a routine advanced cardiological echocardiographic assessment but made little inroads into routine intensive care practice. In particular, there is only very limited research and clinical use of strain and strain rate analysis in critically ill. The opportunities are endless and there is real prospect of clinically meaningful utilization with potential positive impact on outcomes. This chapter is designed to help practitioners with advanced echocardiographic skills to master tissue Doppler and speckle tracking techniques for the use in critical care environment. It describes the necessary technical principles, practical tips, indications and limitations for ICU. This highly illustrated chapter will help to understand complex presentations of tissue analysis in multiple clinical scenarios.