Intravenous myocardial contrast echocardiography for the diagnosis of coronary artery disease (original) (raw)
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Assessment of myocardial perfusion by contrast echocardiography
Revista portuguesa de cardiologia : orgão oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology, 2001
Contrast echocardiography delineates myocardial perfusion and has the potential for quantitating coronary flow and assessing myocardial viability. These applications add important physiologic information to the anatomic information readily available from conventional echocardiography. Because it can be rapidly performed at the bedside, contrast echocardiography may be valuable tool for the use in acute myocardial ischemia. When contrast echocardiography has been used after recanalization of occluded coronary arteries, the assessment of myocardial salvage conveys information concerning reflow, stunning, and prognosis, and in the case of angioplasty it provides immediate information regarding the success of the procedure. Contrast echocardiography can also assess myocardial areas at risk of irreversible damage and the presence or absence of collateral flow. Myocardial contrast echocardiography is a rapidly changing field and with the continued development of newer contrast agents and ...
Myocardial perfusion assessment with contrast echocardiography
Medical Imaging 2001: Ultrasonic Imaging and Signal Processing, 2001
Assessment of intramyocardial perfusion by contrast echocardiography is a promising new technique that allows to obtain quantitative parameters for the assessment of ischemic disease. In this work, a new methodology and a software prototype developed for this task are presented. It has been validated with Coherent Contrast Imaging (CCI®) images acquired with an Acuson Sequoia scanner. Contrast (Optison® microbubbles) is injected continuously during the scan. 150 images are acquired using low mechanical index U/S pulses. A burst of high mechanical index pulses is used to destroy bubbles, thus allowing to detect the contrast wash-in. The study is performed in two conditions: rest and pharmacologically induced stress. The software developed allows to visualize the study (cine) and to select several ROIs within the heart wall. The position of these ROIs along the cardiac cycle is automatically corrected on the basis of the gradient field, and they can also be manually corrected in case the automatic procedure fails. Time curves are analyzed according to a parametric model that incorporates both contrast inflow rate and cyclic variations. Preliminary clinical results on 80 patients have allowed us to identify normal and pathological patterns and to establish the correlation of quantitative parameters with the real diagnosis.
Contrast echocardiography for assessment of myocardial perfusion
Herz, 1997
It has been suggested that the myocardial perfusion can be qualitatively and quantitatively assessed by different ultrasound contrast techniques. It has been reported that the intracoronary or intraaortic administration of the ultrasound contrast agents can be used to visualize perfusion defects or to analyze the coronary flow reserve. The perfusion analysis after intracoronary injection of ultrasound contrast agents sectas to be established, but there are a lot of open questions. A topographic (qualitative) perfusion analysis with visualization of perfusion defects and perfusion areas or analysis of collaterals has been demonstrated. A quantitative analysis of myocardial blood flow has been described but the existing studies ate inconsistent. It i; not known which parameters of the contrast wash-out curves should be used for perfusion analysis and ir the Stewart-Hamilton curve analysis can be transfered to all ultrasound contrast agents asa model for quantitative myocardial blood flow assessment. The development of the transpulmonary contrast agents for echocardiographic eval-uation of left ventricular cavity has the impact for myocardial perfusion imaging. The increase of myocardial intensity does not mean that a qualitative or quantitative perfusion analysis can be clinically used. In this field we have to differentiate between the possibilities of qualitative discrimination of perfusion defects and quantitative perfusion (myocardial blood flow) analysis. The different scanning conditions, the poor transthoracic ultrasound window and insufficient enhancemant of the myocardial intensity make it problematic to quantify the myocardial perfusion. At the moment myocardial intensity will be increased after intravenous injection of transpulmonary contrast agents, but the value for perfusion analysis has not been shown. New ultrasound technologies such as second harmonic imaging, power-mode and raw data analysis have to show the clinical importance of these techniques for perfusion analysis in daily clinical routine. The open questions of the perfusion analysis by contrast echocardiography will be discussed in this review article.
2017
Contact address: Nicoleta Oprescu, MD, Department of Cardiology, Clinical Emergency Hospital, Floreasca Street, No. 8, 014461, Bucharest, Romania. E-mail: nicoleta_m_oprescu@yahoo.com. 1 Clinical Emergency Hospital, Bucharest, Romania Abstract: Objective – Myocardial perfusion can be safely assessed using contrast echocardiography. Our aim is to demonstrate the diagnostic value of resting myocardial contrast echocardiography (MCE), and its correlation with scintigraphy, transthoracic echocardiography and coronary angiography. Method – For the purpose of this study (case-control) we selected two patients, one control patient having cardiovascular risk factors but no ischemic heart disease and another patient with prior myocardial infarction. Left ventricle microperfusion was quantifi ed using multiple techniques: echocardiography, myocardial contrast echocardiography (MCE) and myocardial scintigraphy with 99mTctetrofosmin radiofarmaceutic. Both patients underwent coronary angiography...
Journal of the American College of Cardiology, 2006
Intravenous myocardial contrast echocardiography (MCE) is a recently developed technique for assessment of myocardial perfusion. Up to now, many studies have demonstrated that the sensitivity and specificity of qualitative assessment of myocardial perfusion by MCE in patients with acute and chronic ischemic heart disease are comparable with other techniques such as cardiac scintigraphy and dobutamine stress echocardiography. Furthermore, quantitative parameters of myocardial perfusion derived from MCE correlate well with the current clinical standard for this purpose, positron emission tomography. Myocardial contrast echocardiography provides a promising and valuable tool for assessment of myocardial perfusion. Although MCE has been primarily performed for medical research, its implementation in routine clinical care is evolving. This article is intended to give an overview of the current status of MCE. (J Am Coll Cardiol 2006;48:2168 -77)
Journal of the American College of Cardiology, 2006
Intravenous myocardial contrast echocardiography (MCE) is a recently developed technique for assessment of myocardial perfusion. Up to now, many studies have demonstrated that the sensitivity and specificity of qualitative assessment of myocardial perfusion by MCE in patients with acute and chronic ischemic heart disease are comparable with other techniques such as cardiac scintigraphy and dobutamine stress echocardiography. Furthermore, quantitative parameters of myocardial perfusion derived from MCE correlate well with the current clinical standard for this purpose, positron emission tomography. Myocardial contrast echocardiography provides a promising and valuable tool for assessment of myocardial perfusion. Although MCE has been primarily performed for medical research, its implementation in routine clinical care is evolving. This article is intended to give an overview of the current status of MCE. (J Am Coll Cardiol 2006;48:2168 -77)
Zeitschrift f�r Kardiologie, 2003
Die myokardiale Kontrastechokardiographie zur Analyse der myokardialen Ruhe-Durchblutung bei einer Patientin mit signifikanter Hauptstamm-Stenose n Zusammenfassung Die vorliegende Kasuistik will auf die Möglichkeiten der myokardialen Kontrastechokardiographie (MCE) mit Power Doppler Harmonic Imaging (PDHI) hinweisen, regionale myokardiale Minderperfusionen bei Risikopatienten in Ruhe zu detektieren. PDHI wird nor-malerweise in einem getriggerten Modus angewandt. Die Kontrastmittelbläschen werden durch die Ultraschallenergie der einzelnen Ultraschallpulse im Myokard zerstört. Das Myokard muss anschließend wieder in dem Zeitintervall zwischen den Ultraschall-Pulsen mit Microbubbles gefüllt werden, um repetitiv Information über die Perfusion zu ermöglichen. Mit dem Kontrastmittel Levovist kann PDHI auch im Real-Time-Modus angewandt werden. Die Opazifizierung des Myokards unter diesen Bedingungen repräsentiert vermutlich Perfusionssignale aus einer arteriolären Microbubble-Passage des Myokards. Eine 45-jährige Frau kam in unsere Klinik mit typischer Belastungs-abhängiger Angina pectoris. Die konventionelle 2D-Echokardiographie zeigte eine normale globale linksventrikuläre Pumpfunktion, der Gewebedoppler allerdings eine postsystolische Longitudinalverkürzung des Mitralringes septal, anterior und lateral. Die in Ruhe durchgeführte MCE im getriggerten PDHI-Modus führte zu einer kompletten Opazifizierung des Septums. Die MCE im Real-Time-PDHI-Modus zeigte keine Anfärbung des Septums. Die anschließende Angiographie dokumentierte eine isolierte ungeschützte hochgradige Hauptstammstenose. Nach Angioplastie und Stent-Implantation wurden die MCE-Untersuchungen wiederholt. Während die Opazifizierung des Septums im getriggerten PDHI-Modus unverändert war, zeigte sich nun auch im Real-Time-PDHI-Modus im Gegensatz zur Voruntersuchung eine vollständige Anfärbung des Septums. Der methodische Vergleich zwischen getriggertem und Real-Time-PDHI zeigt offensichtlich, dass die MCE mit unterschiedlichen Techniken und Kontrastmitteln unterschiedliche Gefäß-Kompartimente im Myokard darstellen kann. Die myokardiale Kontrastechokardiographie bietet somit zusätzliche Möglichkeiten im Rahmen der nicht-invasiven Diagnostik bei Patienten mit ischämischer Herzerkrankung.
Echocardiography, 2013
Background: Recently, multimodality imaging has been demonstrated to improve the sensitivity of dobutamine stress for the diagnosis of coronary artery disease (CAD). Objective: We sought to determine the additional value of myocardial perfusion (MP) over wall-motion (WM) analysis for detecting CAD, using real time myocardial contrast echocardiography (RTMCE) and cardiovascular magnetic resonance (CMR), in the same group of patients. Methods: We studied 42 patients who underwent RTMCE and CMR during high-dose dobutamine stress with early injection of atropine. Results: No difference was observed in the diagnostic accuracy of RTMCE and CMR for detecting angiographically significant CAD when considering WM analysis alone (73% [95% CI, 65-81] and 78% [95% CI, 70-84], respectively; P = NS) or combined analysis of WM and MP (80% [95% CI, 73-97] and 83% [95% CI, 77-90], respectively; P = NS). Combined analysis of WM and MP had higher sensitivity than the analysis of WM alone by RTMCE (88% [95% CI, 75-100] vs. 72% [95% CI, 54-90]) and by CMR (92% [95% CI, 81-100] vs. 80% [95% CI,) with no differences in specificity. The association of abnormal WM and MP abnormalities during high-dose dobutamine-atropine stress had additional value for detecting CAD over the analysis of WM alone, both by RTMCE (v 2 = 16.16-24.13; P = 0.005) and CMR (v 2 = 12.73-27.41; P = 0.001). Conclusion: RTMCE and CMR using the same dobutamine-atropine stress protocol had comparable diagnostic accuracies for the detection of angiographically significant CAD. MP imaging had additional value over WM analysis for the diagnosis of CAD, both at RTMCE and CMR. (Echocardiography 2013;30:45-54)
Japanese Heart Journal, 2001
Using a high frequency ultrasonic transducer, intramyocardial coronary blood flow (IM-CBF) can be visualized and evaluated during hemodynamic changes in the anterior wall and septum of the left ventricle (LV). We tested the hypothesis that detection and quantitative measurement of IM-CBF of entire LV segments are feasible using a high frequency ultrasonic transducer in conjunction with intravenous contrast injection in vivo. A 3-8 MHz transducer was used to image and measure IM-CBF in 10 anesthetized dogs. We obtained a color Doppler image of IM-CBF in the LV short-axis view after intravenous Levovist(TM) injection (25 mg / ml). The IM-CBF velocity was recorded using spectral Doppler in the antero-septal and infero-posterior wall of closed chest dogs and in the entire LV after opening the chest. A significant increase in IM-CBF velocity was observed in all LV regions after adenosine 5'-triphosphate (ATP) administration. After Levovist(TM) injection, the visualization of IM-CBF was improved and the spectral Doppler pattern of coronary flow velocity was clarified compared to baseline. IM-CBF was assessed in the antero-septal region of the LV before and after left anterior descending coronary artery occlusion. A high frequency ultrasonic transducer in conjunction with intravenous contrast injection improved IM-CBF visualization, enabling quantitative evaluation of the intramyocardial coronary circulation in the entire LV after coronary occlusion and hyperemia. This study may represent a step towards noninvasive assessment of myocardial perfusion before and after coronary reperfusion.