The reproducibility of contrast-enhanced echocardiography is as good that of MRI. For assessment of global and regional LV function, there are large controlled trials including several hundred patients. The accuracy of stress echocardiography is no worse than that of myocardial scintigraphy. Multislice CT is a new technology that displays the coronary arteries rather than looking for myocardial ischaemia.
There is an ongoing debate as to whether non-invasive coronary angiography really provides the best information for the management of patients; however, there is consensus that functional assessment of coronary stenoses with stress tests cannot be given up.
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For single tests, however, the incidence of side effects appears to be very low for all imaging technologies. Therefore, it is difficult to establish a significant superiority of one method over another in terms of safety. Postmarketing surveillance, anecdotal reports on adverse events and a few articles on local registries are other sources to compare different technologies. However, these studies represent different populations and different methods of clinical care.
In many patients the clinical course requires several appointments for cardiac imaging. Radiation dosages become an issue in those patients who require non-invasive or invasive coronary angiography and coronary interventions. This has to be taken into account when patients need functional imaging. Contrast application can close the gap between MRI and echocardiography in those patients with suboptimal images. Even with the use of contrast, echocardiography remains a very cost-effective test that can be easily integrated into the workflow, either as an outpatient appointment or as treatment on the ward.
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Contrast Application Is Useful Only if it Alters Patient Management The threshold for ultrasound examinations is usually very low and the results of the examinations do not always affect patient management. Safety of Contrast Echocardiography Side effects have been reported for ultrasound contrast agents, but they are usually mild. Echocardiography Is the Method of Choice for Repetitive Cardiac Imaging In many patients the clinical course requires several appointments for cardiac imaging. Oxford specialist handbook of cardiology, Oxford University Press, Free download: www.
Crossref PubMed Becher H, et al. Crossref PubMed. View All Articles. Resting left ventricular LV systolic function was deemed normal if all 17 segments had normal contractility and abnormal if any segment exhibited a WM abnormality. The presence of ischemia was defined as a new or worsening WM abnormality at peak stress, including a biphasic response during viability studies, in any segment.
MCE was performed in the apical four-chamber, two-chamber, and three-chamber views using both low-power real-time and triggered end-systolic imaging. Time-gain compensation and background gain settings were optimized so that minimal tissue signal was seen. All patients received intravenous infusion of SonoVue at 0. The infusion rate was adjusted to optimize myocardial opacification with minimal attenuation.
Additionally, for those patients performing exercise, an intravenous bolus injection 0. Nonstandard apical views e. In dilated hearts, each myocardial wall e. Flash echocardiography at a high mechanical index 0. Real-time and end-systolic triggered images were acquired digitally up to 15 cardiac cycles after microbubble destruction in each view. If patients have normal resting LV function, then MP by definition must be normal also.
In these patients, MCE was performed only at rest in one view usually apical four-chamber to optimize settings flash frames, flash mechanical index, gain, and time-gain compensation for performing MCE at peak stress, which was done immediately after WM cine loops had been acquired.
Contrast echocardiography: does it have a future?
We perform MCE after WM cine loops have been acquired because we believe the side-by-side comparison of rest and stress WM loops, in the quad-screen format, facilitates the accurate identification of WM abnormalities. This viewing format is not possible if individual cine loops are acquired. However, as contrast is being given by continuous intravenous infusion in these patients, we can assess myocardial signal intensity i.
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A perfusion defect was deemed to be present at rest if, in the presence of a WM abnormality, there was patchy or absent contrast uptake or delayed perfusion beyond 5 sec after microbubble destruction. Ischemia was deemed present when subendocardial or transmural defects appeared that replenished beyond 1 sec after flash.
Worsening of resting perfusion was also deemed indicative of ischemia. This was performed on a segmental basis using the same segment LV model used for WM analysis.
Recent advances in myocardial contrast echocardiography
The value of assessing MP to the reporting cardiologist, in addition to WM, was determined at the time of image interpretation, immediately after completion of the test, and assigned to predefined categories. No added benefit over WM analysis was defined as follows: WM is unequivocally abnormal and MP is correspondingly abnormal i.
It is for this reason that we accepted such scans and categorized MP assessment as of incremental benefit. MCE was performed by staff echocardiologists at our institution, most of whom were doctors in training. All were familiar with and independent operators for conventional stress echocardiographic techniques i. Thereafter, stress and myocardial contrast echocardiographic studies were performed independently but coreported with the expert reader, who decided the final assessment by WM and MP.
Patients were referred for coronary angiography CA at the discretion of their responsible cardiologists, and WM and MP results were available to help inform this decision-making process. Coronary angiographic studies within 3 months of SE were included in the results, providing patients did not have any cardiac events in the intervening time period. Analyses were then performed to determine the relative accuracy of WM and MP for detecting CAD overall, by coronary territory left anterior descending coronary artery [LAD], left circumflex coronary artery, and right coronary artery territories and by grouped coronary territory i.
Ischemic burden is expressed as median interquartile range [IQR].
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All statistical analyses were performed using both Stata version Acute Coronary Occlusion. Chest Wall and Wall Motion Artefacts. Echocardiography Contrast Agents. Imaging Modalities. Chapter6 Contrast Echocardiography for Left Ventricular. Imaging Methods for. Can Echocardiography Provide Combined. Integrating Contrast Echocardiography inthe Diagnostic. Myocardial Perfusion and Other Future Applications. Bibliografische Informationen. Future Trends.
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