Use Of Contrast Echocardiography Research Articles

The usefulness of contrast echocardiography in the evaluation of cardiac masses: a multicenter study

BackgroundCardiac masses can encompass a variety of conditions, such as tumors, thrombi, vegetations, calcific lesions, and other rare diseases. Treatment and management of these types of cardiac masses differ considerably. Thus, accurately distinguishing among thrombi, benign tumors, and malignant tumors in the heart is of great importance. Contrast echocardiography (CE) has emerged as a promising technology. Although published guidelines suggest that CE can enhance image quality and assist in differentiating between benign and malignant lesions, most studies on CE diagnosis of cardiac masses are limited to case reports or retrospective/small-sample-sized prospective cohorts. This study aims to evaluate the diagnostic accuracy of CE in patients with suspected cardiac masses and address the insufficient evidence for differential diagnosis using CE.MethodsBetween April 2018 and July 2022, a prospective multicenter study was conducted, which included 145 consecutive patients suspected to have cardiac masses based on transthoracic echocardiography. All patients underwent CE examinations. The echocardiographic diagnosis relied on qualitative factors such as echogenicity, boundary, morphology of the base, mass perfusion, pericardial effusion, and motility as well as quantitative factors such as the area of the masses and the peak intensity ratio of the masses to adjacent myocardium (A1/A2).ResultsThe final confirmed diagnoses were as follows: 2 patients had no cardiac mass, 4 patients had pseudomass, 43 patients had thrombus, 66 patients had benign tumors, and 30 patients had malignant tumors. The receiver operating characteristic (ROC) analysis indicated that an optimal A1/A2 cutoff value of 0.499 distinguished a cardiac tumor from a thrombus, with AUC, sensitivity, specificity, PPV, and NPV of 0.977, 97.9%, 90.7%, 95.9%, and 95.1%, respectively. The optimal A1/A2 cutoff value of 1.583 distinguished a cardiac tumor from a thrombus, with AUC, sensitivity, specificity, PPV, and NPV of 0.950, 93.3%, 93.9%, 87.5%, and 96.9%, respectively.ConclusionsCombined with qualitative and quantitative analyses, CE has the potential to accurately differentiate among different types of cardiac masses.

Usefulness of contrast echocardiography for detection of left ventricular thrombus in a real-world population with acute anterior myocardial infarction

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction The treatment of ST-elevation myocardial infarction (STEMI) has considerably changed in recent years, with early, mainly transcatheter reperfusion therapy improving survival. However, left ventricular thrombus (LVT) is still reported as a relatively common complication especially in anterior STEMI. Two-dimensional transthoracic echocardiography (TTE) is the most commonly used diagnostic modality in this setting due to its wide availability and low cost but can lead to misdiagnoses. The use of ultrasound contrast agents has dramatically improved the visualization of cardiac chambers and thus detection of LVT. Purpose The purpose of this study was to assess the value of contrast echocardiography (CE) for the detection of apical LVT in a real-world population of patients with acute anterior myocardial infarction (MI) in the modern era. Methods The population of this prospective study consisted of consecutive patients presenting within a year with acute anterior MI in a tertiary hospital with capability of primary percutaneous coronary intervention (PCI). Patients with confirmed COVID-19 infection and/or current use of anticoagulant medication were excluded from the study. All patients underwent TTE without and with contrast within 7 days post-MI by an experienced cardiologist. CE was considered the reference standard. Results A total of 102 patients (mean age 61±13 years, 19% female) with anterior STEMI were prospectively recruited in our study. Ninety-eight patients underwent primary PCI, 3 patients underwent rescue PCI after unsuccessful thrombolysis, 1 patient underwent surgical revascularization. Two patients did not receive contrast agent (1 due to known hypersensitivity to contrast agent and 1 due to cardiogenic shock). Mean ejection fraction (EF) was 46% ± 10% in total population and was significantly lower in patients with LVT (42% ± 7% vs 47% ± 10%, p = 0.025). The incidence of confirmed LVT by CE was 28% (28/100) within 7 days post-MI. In total, 8 out of 28 LVT cases (28.5%) would have been missed using TTE without contrast within 7 days post-MI (sensitivity 71%, specificity 100%, positive predictive value 100% and negative predictive value 90%). Example of missed LVT on TTE without and with contrast (left and right panel respectively) is shown in Figure 1. Conclusions LVT is not uncommon after anterior STEMI in the modern era of primary PCI. LVT would have been missed in a significant proportion of patients with anterior STEMI if CE was not used, depriving these patients from the option of early anticoagulation treatment.

813 The added value of transthoracic three dimensional echocardiography in apical hypertrophic cardiomyopathy

Abstract We present the case of a 73-year-old patient with a recent diagnosis of hypertrophic cardiomyopathy (HCM). He was asymptomatic and has no family history of sudden cardiac death (SCD), syncope or ventricular arrhythmias. An echocardiogram performed at the moment of diagnosis (2020), showed left ventricular (LV) asymmetric apical hypertrophy with maximal wall thickness of 21 mm. Cardiac magnetic resonance (CMR) confirmed LV apical hypertrophy with mid-ventricular obliteration, and late gadolinium enhancement in the apical segments, without wall motion abnormalities present at rest. According to 2014 ESC guidelines, his calculated risk score for sudden cardiac death was low (1.23% at 5 years). On 2021, a comprehensive transthoracic echocardiographic examination including advanced techniques (three-dimensional echo-3DE-, and two-dimensional speckle-tracking-2DSTE) was done as part of his routine follow-up in our cardiomyopathy outpatient clinic. The echo study showed an asymmetric pattern of LV hypertrophy with a maximal wall thickness of 21 mm at the level of the anterolateral apical segment, normal LV volumes (end-diastolic volume 55 mL/m2) and ejection fraction (69%) by 3DE. LV longitudinal strain analysis by 2DSTE showed impaired LV myocardial deformation mainly at the apical LV segments (GLS = −13.6%). There was evidence of dynamic intracavitary obstruction (maximal gradient 32 mmHg at rest and raised to 52 mmHg during Valsalva manoeuvre). 3DE views of the LV (both multi-slice display and 3D rendered image) allowed to avoid foreshortening of the LV apical views, and to appreciate the actual wall motion at the real LV apex. They revealed a LV apical aneurysm which was not detected in the conventional LV-focused apical 2D views (Figure 1A and B). Apical hypertrophic cardiomyopathy (ApHCM) is a variant of HCM that is characteristic of focal thickening of the LV apical myocardium and was reported to have a more benign course than other non-apical forms. However, the presence of LV aneurysm in ApHCM patients is associated with an increased risk for ventricular arrhythmias, sudden cardiac death and thromboembolism. Accordingly, the detection of apical LV aneurysms has significant impact on patient management. Guidelines recommend the use of contrast echocardiography or CMR when the apical region of the LV is suboptimally visualized by conventional 2D echocardiography. However, contrast echocardiography may still be affected by apical foreshortening resulting in suboptimal accuracy, as it is a 2D technique. On the other end, CMR may be contraindicated or not widely available for routine yearly follow-up for all HCM patients requiring regular imaging follow-up. Our clinical case emphasizes the added value of 3DE to increase the sensitivity of transthoracic echocardiography in detecting apical LV aneurysms in patients with apical HCM with important clinical implications for the management of the patient. 813 Figure 1(A) 2D 4chamber-view showing maximal wall thickness in the apical segments (21 mm) with apical obliteration. At a first evaluation, apical aneurism is not easily detected. (B) 4D rendering of the apex showing the apical aneurism.

A review of the safety and clinical utility of contrast echocardiography.

There are limitations to the sensitivity and specificity of conventional two-dimensional echocardiograms in making an accurate diagnosis in certain patient populations. This led to the development of specific contrast-enhancing agents with the following characteristics: small enough to cross the pulmonary capillary bed, remain stable throughout the length of the procedure, do not dissolve in blood, and rapidly cleared from the body with low toxicity. Unfortunately, the use of contrast echocardiography has not taken off as expected. The low take-up rate among clinicians can largely be attributed to the black box warning by the United States Food and Drug Administration in 2007, after the coincidental occurrence of four patient deaths and about 190 severe cardiopulmonary reactions shortly after contrast agent administration. In this article, we address the clinical safety of contrast agents, share our institution's experience in using it and elaborate on the clinical indications of contrast echocardiography.

Usefulness of contrast echocardiography in the diagnosis of left ventricular pseudoaneurysm.

Usefulness of contrast echocardiography in the diagnosis of left ventricular pseudoaneurysm.

Применение контрастной эхокардиографии в диагностике апикальной гипертрофической кардиомиопатии. Клинический случай и литературная справка

Применение контрастной эхокардиографии в диагностике апикальной гипертрофической кардиомиопатии. Клинический случай и литературная справка

Evaluation and Management of Cardiac Tumors.

Our purpose is to discuss the importance of multimodality imaging in the assessment of cardiac tumors and management. We have compiled a recent review of the scientific literature and embedded our clinical pathways and recommendations based on data and clinical experience. The use of contrast echocardiography in the assessment of cardiac masses has been shown to be helpful in distinguishing tumor from thrombus. Deformation imaging of cardiac tumors has been shown to differentiate better rhabdomyomas from fibromas in pediatric patients. Cardiac MRI (CMR) appears to be helpful in determining whether cardiac tumors are benign or malignant by identifying presence of infiltration, uptake of contrast in first pass perfusion and gadolinium enhancement. Patients with evidence of cardiac metastases by CMR show similar survival to stage IV cancer without cardiac metastases. In our institution, we use a standardized approach for the evaluation of cardiac masses, which includes multimodality imaging in the appropriate clinical context. The autotransplantation surgical technique has shown some promise in improving survival in patients with primary cardiac sarcomas. In our institution, we do not routinely recommend anticoagulation for "tumor-thrombus" in renal cell carcinoma due to risk of bleeding from primary tumor. Cardiac masses are often found incidentally, but sometimes can present with cardiovascular symptoms due to obstruction and valvular dysfunction, which may prompt imaging. It is important to determine whether the mass is a normal variant, imaging artifact, vegetation, thrombus, or tumor. Transthoracic echocardiography is ideally suited to be the initial imaging modality because of the portability, wide availability, lack of radiation, and relatively low cost. The gold standard cardiac imaging technique to distinguish tumor from thrombus is contrast enhanced CMR with prolonged inversion time. Advantages of CMR when compared to echocardiography regarding characterization of cardiac tumors are as follows: larger field of view, better spatial resolution, better tissue characterization, lack of attenuation, and ability to image at any prescribed plane. Primary and secondary cardiac tumors have particular characteristics in echocardiography and CMR. Imaging of cardiac tumors plays an important role in establishing a diagnosis and in planning management.

Contrast Echocardiography

Ultrasound contrast agents are widely used in clinical practice for left ventricle opacification in sub-optimal echocardiograms. Recently, significant research has focused on the use of contrast echocardiography as a non invasive means to evaluate myocardial perfusion. Advances in contrast agents as well as ultrasound technology have enabled investigations into myocardial contrast echocardiography as a possible alternative to nuclear imaging studies. This review will focus on the development and current uses of contrast echocardiography, as well as future indications, including myocardial perfusion and risk stratification following myocardial infarction.

Clinical Usefulness of Contrast Echocardiography

Two-demensional echocardiography is routinely used for evaluation of cardiac function. Visualization of the endocardial border is essential for the assessment of global and regional left ventricular with cardiac disease. SonoVue TM is a microbubble contrast agent that consists of sulfur hexafluoride-filled microbubbles in a phospholipid shell. There were many studies about contrast echocardiographic examination using SonoVue TM contrast agent, and various doses of SonoVue TM were used. To our knowledge, in published veterinary medicine, there was not reported for diagnostic efficient dose of SonoVueTM to evaluate contrast enhanced left ventricular endocardial border delineation (LVEBD). The purpose of this study is to compare the visualization time of LVEBD and find efficient dose of SonoVue TM for using various doses in dogs. Ten healthy Beagles were recruited to the study. Three different doses (0.03 ml/kg, 0.05 ml/ kg and 0.1 ml/kg) of SonoVue TM were injected. Endocardial segments were assigned based on previously established methodology, where by the four-chamber views of the LV were divided into 6 segments. In this study, Contrast enhancement of the LVEBD after each injection was evaluated visually at the time point of overall contrast enhancement (Segmental scoring 5+) in the LV by three investigators in a blind manner. Statistical analysis was performed with SPSS version 14.0. All data were analyzed using one-way ANOVA, the multiple comparison Scheffe test. When data for the three offsite readers were combined, mean durations of useful contrast were 3.54 (± 2.14), 6.15 (± 2.61), and 24.39 (± 11.10) seconds for the 0.03 ml/kg, 0.05 ml/kg, and 0.1 ml/kg SonoVue TM doses, respectively. After injection of contrast agent, there were no significant change in side effects such as urticaria, angioedema, hypersensitivity reactions, and digestive system disorders. This study suggests that efficient dose of SonoVue TM contrast agent for improvement of the left ventricle visualization is 0.1 ml/kg. The duration of useful enhancement of LVEBD and the reproducibility were also the highest at the 0.1 ml/kg dosage.

DETERMINATION OF NORMAL LV VOLUME AND EF BY CONTRAST ECHO AND COMPARISON WITH CARDIAC MRI

BACKGROUND: Ultrasound contrast agents have been recommended for assessment of LV volume and EF when the acoustic windows are poor. There is limited data comparing these measurements directly to those obtained using cardiac MRI (cMRI), which is regarded as the gold standard for LV volume and EF assessment. Hence, in the recently published ASE guidelines for chamber quantification, no normal valuef end-diastolic and end-systolic LV volume by contrast echo are provided. We aimed to compare the LV volumes and EF measured by contrast echocardiography with cMRI in patients with normal cardiac chamber size. METHODS: The Alberta Heart study is a large provincial registry in whom healthy volunteers and patients with heart failure with preserved ejection fraction undergo both echocardiographic and cMRI scans for assessment of LV volumes and EF. Patients were included if they had a cMRI and contrast echocardiogram performed within seven days of each other, and had normal LV size by cMRI (using normal values from 2013 ESC guidelines). LVEF by contrast echo was measured by biplane method of disks using bolus Definity contrast to optimize the endocardial definition. Correlation and mean differences between LV end-diastolic volume index (LVEDVI), LV end-systolic volume index (LVESI) and EF measured by contrast echo were compared to cMRI using t-tests and Pearson’s method, respectively. RESULTS: There were 69 patients with normal LV volumes by cardiac MRI. Duration between echo and MRI was 0.6 +/1.0 days. Mean LVEDVI measured by cardiac MRI was 68.4 +/12.2mL/m2 and 56.9 +/12.3mL/m2 by contrast echo (p<.0001). LVESVI obtained from MRI was 27.8 +/9 mL/ m2 compared to 22.5 +/7.5 mL/m2 by contrast echocardiography (p<.0001). There was correlation of LVEDVI between the two modalities (K1⁄40.587, p<0.001). There was no significant difference in the mean LV ejection fraction between MRI and contrast echocardiography (59.7 +/9.7% vs. 60.6 +/9.6 % respectively, p1⁄44.3). CONCLUSION: In a group of patients with normal LV size according to the gold standard cMRI, contrast echo underestimated LVEDVI by 11.5mL/m2 (17%) and LVESVI by 5.3 mL/m2 (19%). These differences should be taken into consideration when comparing volume measurements done with these modalities. Contrast echo was accurate compared with cMRI in assessment of LVEF. Considering the growing use of contrast echocardiography, a national registry is suggested to broaden the basis for normal values in this modality.

The Use of Contrast Echocardiography to Identify Infiltrating Lymphoma in the Myocardium

Introduction Echocardiographic contrast agents are approved by the US Food and Drug Administration (FDA) for delineation of the LV endocardium however its role in the assessment of myocardial disease has not been defined [1]. Contrast echocardiography has demonstrated an ability to better differentiate myocardial tissue with respect to myocardial blood flow. Ultrasound contrast agents have been demonstrated to be useful in differentiating thrombi from benign and malignant neoplasms that are confined to the endocardium [1,2]. We present a clinical example where non-contrast and contrast enhanced echocardiograms demonstrated remarkably different myocardial compositions. In our patient, contrast enhanced echocardiography identified infiltrating lymphoma in the myocardium that was not seen with standard 2D imaging. Case Description 68 year-old African American man, with a past medical history of AITL and hepatitis C virus, presented with 2 weeks of weakness and fatigue. Symptoms were associated low grade fevers, but were non-exertional and not associated with chest pain, shortness of breath, dyspnea on exertion or cough. Medical history included AITL with autoimmune hemolytic anemia, initially diagnosed 3 years prior to admission. Patient completed CHOP (Cyclophospharmide/Doxorubicin/Vincristine) Chemotherapy. He was in remission until 2 months prior to this admission; at which point he was found to have recurrence in his right axillary lymph node and was started on ICE (Ifosfamide/Carboplatin/Etoposide). There was no known history of cardiovascular disease. Physical exam revealed tachycardia, positive jugular venous distention, bibasilar crackles on pulmonary exam, and +1 pitting peripheral edema. Cardiac exam displayed regular rate and rhythm, with normal S1/S2 but cardiac sounds were muffled. Labs showed a BMP within normal limits. CBC revealed a leukocytosis (Wbc=23.8 10xe3/mm3) with a left shift with a new anemia (Hgb of 8.5 g/dl) and thrombocytopenia (Plt=67 10xe3/mm3). Additionally, a BNP=442 pg/ml and Trop=0.12 ng/ml

DIAGNOSIS OF LV THROMBUS: A DEFINITE ROLE FOR CONTRAST ECHOCARDIOGRAPHY?

Patients with documented LV thrombus following acute anterior myocardial infarction are at a higher risk of thromboembolic complications. Clear distinctions between the echocardiographic interpretations of “suspected LV thrombus”, “unable to rule out thrombus”, and “no thrombus”, are important as they carry differing strengths of recommendation for anticoagulation use in current ACS treatment guidelines. Both the 2007 CCS and 2008 ASE consensus statements advocate for use of contrast echocardiography to confirm or exclude apical thrombus. We sought to define current use of contrast echocardiography in this context and its impact on clinical decision making. This was a sub-study of a prospective, observational study of 50 consecutive patients admitted to the CCU at Vancouver General Hospital between December 2012 to January 2014 who had an acute anterior MI complicated either by documented LV thrombus or LV dysfunction (LVEF ≤40%) along with apical or anterior wall akinesis. Transthoracic echocardiography (TTE) was used for quantification of LV function and detection of LV thrombus. Contrast echocardiography, using Definity (Perflutren Lipid Microsphere, Lantheus Medical Imaging) was available in all cases. The decision to use contrast TTE was left to the attending cardiologist. Anticoagulation use was determined by the discharge prescription on record. In this group, 24/49 (49%) had TTE evidence of LV thrombus or were unable to rule out thrombus. TTE documented LV thrombus in 7 (14%) patients. In one of these cases, contrast TTE was used, and was negative, disproving LV thrombus and leading to discontinuation of anticoagulation. In 17 (35%) patients, initial TTE was unable to rule out LV thrombus. Contrast TTE was used in 10/17 (58.8%) indeterminate cases. Of these contrast TTE scans, 9/10 ruled out LV thrombus leading to discontinuation of anticoagulation. One contrast TTE was positive for LV thrombus and led to prescription of anticoagulation. Of the remaining 7/17 (41%) indeterminate TTE, 4 patients were anticoagulated empirically and 3 patients were kept on dual antiplatelet only. LV thrombus is difficult to confidently image using standard TTE. As recommended by national guidelines, contrast echocardiography can be useful to aid in the diagnosis of apical thrombus. In our study, management decisions regarding anticoagulation were concordant with contrast echo results in all 11 cases. Further study into the routine use of contrast echocardiography as part of a clinical decision making algorithm for high risk MI patients with an indeterminate standard TTE is needed.

Significance of left ventricular clefts—A case report

We describe the case of a 48-year-old patient who presented with an out-of-hospital cardiac arrest due to an acute ST-elevation myocardial infarction. Left ventriculography performed during the initial coronary angiography revealed the presence of structural abnormalities in the myocardial wall which subsequently, with the use of contrast echocardiography and cardiac magnetic resonance imaging, were confirmed to represent ventricular clefts. We reviewed the pathophysiological significance of these defects and compared them with similarly looking abnormalities such as aneurysms, pseudoaneurysms, and diverticula. In conclusion, recognition of ventricular clefts is needed to allow clinicians to differentiate them from other myocardial wall defects with different pathological profile and clinical significance.<Learning objective: With emerging techniques in cardiac imaging some cardiac abnormalities such as left ventricular (LV) clefts are recognized more frequently. This case report describes an incidental finding of LV cleft and provides an extensive review of the literature regarding the clinical significance and differential from other similar findings of different pathology. That will help physicians to distinguish these overlapping findings and tailor patients’ management accordingly.>

Contrast Echocardiography: Current Applications and Future Perspectives

Contrast echocardiography is an established imaging method and an essential tool in every state of the art echocardiographic laboratory. It has also been the subject of several major clinical and research studies during the last year. This article addresses the impact of these studies on the clinical use of contrast echocardiography. Most recent studies have been performed with commercially available ultrasound contrast agents, which cross the pulmonary vasculature and are used for assessment of the left heart. The principle licensed indication for these contrast media is the delineation of left ventricular (LV) borders, masses, and aneurysms. The superiority of 2-dimensional contrast echocardiography over nonenhanced 2-dimensional imaging has been confirmed for assessment of LV volumes and ejection fraction, and there is growing evidence for the use of contrast 3-dimensional echocardiography. Two studies have demonstrated the usefulness of contrast-enhanced TEE for detection of thrombi in the left atrial appendage. The improved endocardial definition seen with ultrasound contrast media can also be used for strain analysis on selected systems. In stress echocardiography, contrast has been used for myocardial perfusion imaging in addition to assessment of regional LV wall motion. A large European multicenter study has demonstrated Sonovue-enhanced myocardial contrast echocardiography to be more sensitive than nuclear single photon emission computed tomography (SPECT) for the detection of significant coronary artery disease. Two further studies are discussed, which have demonstrated the impact of isolated perfusion defects on patients’ outcome. In addition, several publications have supplemented existing evidence regarding the safety of commercially available contrast agents. Recent studies continue to establish the usefulness and safety of contrast echocardiography for the currently licensed indications. There is also now good evidence for the use of myocardial contrast echocardiography as an alternative to nuclear imaging.

Diagnosis of Double‐Chambered Left Ventricle Using Advanced Cardiovascular Imaging

Double-chambered ventricle is a rare congenital cardiac abnormality, most commonly affecting the right ventricle. Here, we report a case of an incidental diagnosis of this condition affecting the left ventricle (LV), which is found much less frequently, and the use of contrast echocardiography in its evaluation. The addition of computed tomography (CT), highlighting the blood supply of both chambers by the left anterior descending (LAD) artery allowed us to confirm the diagnosis.

A novel application of contrast echocardiography to exclude active coronary perforation bleeding in patients with pericardial effusion

Management of hemodynamically significant cardiac tamponade will most often require pericardial drainage. In the absence of hemodynamic evidence of tamponade, however, management of a pericardial effusion represents a clinical dilemma. Pericardial leakage of blood may be transient, and extravasation may have stopped by time of echocardiographic assessment. Besides its usefulness in ischemic heart disease, contrast echocardiography might be applied in the context of coronary perforations. We report the use of contrast echocardiography in four cases of coronary perforation without overt signs of cardiac tamponade as a tool to streamline decision making as to whether perform pericardiocentesis or not. Our series demonstrate the clinical utility and effectiveness of echocardiographic contrast imaging to confirm or exclude active bleeding into the pericardial space when not otherwise visible by conventional imaging measures.

Use of contrast echocardiography for quantitative and qualitative evaluation of myocardial perfusion and pulmonary transit time in healthy dogs

To evaluate reproducibility of ejection fraction (EF), myocardial perfusion (MP), and pulmonary transit time (PTT) measured in a group of dogs by use of contrast echocardiography and to examine safety of this method by evaluating cardiac troponin I concentrations. 6 healthy dogs. 2 bolus injections and a constant rate infusion of contrast agent were administered IV. Echocardiographic EF was determined by use of the area-length method and was calculated without and with contrast agent. The PTT and normalized PTT (PTT/mean R-R interval) were measured for each bolus. Constant rate infusion was used for global MP evaluation, and regional MP was calculated by use of a real-time method in 4 regions of interest of the left ventricle. Cardiac troponin I concentration was analyzed before and after contrast agent administration. Intraoberserver and interobserver variability was calculated. EF was easier to determine with the ultrasonographic contrast agent. For the first and second bolus, mean ± SD PTT was 1.8 ± 0.2 seconds and 2.1 ± 0.3 seconds and normalized PTT was 3.4 ± 0.3 seconds and 3.5 ± 0.3 seconds, respectively. A coefficient of variation < 15% was obtained for global MP but not for the regional MPs. No differences were detected between precontrast and postcontrast cardiac troponin I concentrations. Contrast echocardiography appeared to be a repeat-able and safe technique for use in the evaluation of global MP and PTT in healthy dogs, and it improved delineation of the endocardial border in dogs.

The effect of carvedilol on contrast echocardiography in comparison to metoprolol in conscious dogs

This animal study was to demonstrate the effect of the betablockers carvedilol (CAS 72956-09-3) and metoprolol (CAS 37350-58-6), respectively, on myocardial perfusion which was quantified by the use of contrast echocardiography. Each of four experimental schemes were applied consecutively to each of six dogs. They were pretreated with oral administration of either carvedilol (2 mg/kg b. wt.) or with metoprolol (4 mg/kg b. wt.), or received no premedication. 2 h later the contrast agent BY963 (0.03 ml/kg)--a new transpulmonary contrast agent for sonography, based on phopspholipid stabilized microbubbles--was injected intravenously three times at intervals of 2.5 min 5 min in advance and 7.5, 10, 20, and 30 min following the first injection 60 digitized echocardiography images were recorded during a time period of each 2.9 s. From these images average grey-scale values at predetermined points of time were derived. Time-intensity curves of the region of interest of the interventricular septum were computed. Changes in intensity were calculated by baseline subtraction. Myocardial opacification was observed with all injections of the contrast agent in each dog. The effects were marked and no non-responder was observed. There was no return to baseline grey-scale values within the observation period (30 min). Pretreatment with carvedilol was followed by a more pronounced contrast intensity than was with metoprolol. All administrations were well tolerated. No changes in ECG were observed. Heart rate decrease was marked on metoprolol. Blood pressure dropped to a greater extent on carvedilol compared to metoprolol.

Use of Contrast Echocardiography to Detect Displacement of the Needle during Pericardiocentesis

Bedside pericardiocentesis is a safe and routinely practiced procedure. We report a case in which echocardiography-guided pericardiocentesis was performed urgently for cardiac tamponade. In this case, there was displacement of the periocardiocentesis needle that was only detected by change in the color of aspirated fluid and confirmed by the use of contrast echocardiography. We prescribe the use of routine echocardiographic monitoring during pericardiocentesis to avoid this type of complication.

Use of Contrast Echocardiography in Intensive Care and at the Emergency Room

Bedside echocardiography in emergency room (ER) or in intensive care unit (ICU) is an important tool for managing critically ill patients, to obtain a timely accurate diagnosis and to immediately stratify the risk to the patient’s life. It may also render invasive monitoring unnecessary. In these patients, contrast echocardiography may improve quality of imaging and also may provide additional information, especially regarding myocardial perfusion in those with suspected coronary artery disease. This article focuses on the principle of contrast echocardiography and the clinical information that can be obtained according to the most frequent presentations in ER and ICU.