1
|
Tian Y, Lin J, Yang X, Zeng D, Hu Y, Chen J, Wu Z, Deng X. A rare morphology of the cardiac fibroma in a child: a case report. Front Cardiovasc Med 2024; 11:1357747. [PMID: 38606376 PMCID: PMC11008678 DOI: 10.3389/fcvm.2024.1357747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/08/2024] [Indexed: 04/13/2024] Open
Abstract
Here we report a rare morphology of a cardiac fibroma in a child. A 2-year and 8-month-old toddler came for "chronic constipation" and was found to have a heart murmur on cardiac auscultation. Further transthoracic echocardiography suggested "a strong echogenic mass in the left ventricular wall, with some part of "a string of beads" in shape extending into left ventricle outflow tract", which was atypical for either a tumor, thrombus or vegetation. The child underwent resection of the mass and mitral valvuloplasty. Pathological examination confirmed the mass as a cardiac fibroma.
Collapse
Affiliation(s)
- Yunfei Tian
- Heart Center, The Affiliated Children’s Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Jiayi Lin
- Heart Center, The Affiliated Children’s Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Xiaohui Yang
- Heart Center, The Affiliated Children’s Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Debin Zeng
- Heart Center, The Affiliated Children’s Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Yuan Hu
- Department of Echocardiography and Ultrasound, The Affiliated Children's Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Jingnan Chen
- Heart Center, The Affiliated Children’s Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Zhongshi Wu
- Heart Center, The Affiliated Children’s Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Xicheng Deng
- Heart Center, The Affiliated Children’s Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| |
Collapse
|
2
|
Pergola V, Cameli M, Mattesi G, Mushtaq S, D’Andrea A, Guaricci AI, Pastore MC, Amato F, Dellino CM, Motta R, Perazzolo Marra M, Dellegrottaglie S, Pedrinelli R, Iliceto S, Nodari S, Perrone Filardi P, Pontone G. Multimodality Imaging in Advanced Heart Failure for Diagnosis, Management and Follow-Up: A Comprehensive Review. J Clin Med 2023; 12:7641. [PMID: 38137711 PMCID: PMC10743799 DOI: 10.3390/jcm12247641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/02/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
Advanced heart failure (AHF) presents a complex landscape with challenges spanning diagnosis, management, and patient outcomes. In response, the integration of multimodality imaging techniques has emerged as a pivotal approach. This comprehensive review delves into the profound significance of these imaging strategies within AHF scenarios. Multimodality imaging, encompassing echocardiography, cardiac magnetic resonance imaging (CMR), nuclear imaging and cardiac computed tomography (CCT), stands as a cornerstone in the care of patients with both short- and long-term mechanical support devices. These techniques facilitate precise device selection, placement, and vigilant monitoring, ensuring patient safety and optimal device functionality. In the context of orthotopic cardiac transplant (OTC), the role of multimodality imaging remains indispensable. Echocardiography offers invaluable insights into allograft function and potential complications. Advanced methods, like speckle tracking echocardiography (STE), empower the detection of acute cell rejection. Nuclear imaging, CMR and CCT further enhance diagnostic precision, especially concerning allograft rejection and cardiac allograft vasculopathy. This comprehensive imaging approach goes beyond diagnosis, shaping treatment strategies and risk assessment. By harmonizing diverse imaging modalities, clinicians gain a panoramic understanding of each patient's unique condition, facilitating well-informed decisions. The aim is to highlight the novelty and unique aspects of recently published papers in the field. Thus, this review underscores the irreplaceable role of multimodality imaging in elevating patient outcomes, refining treatment precision, and propelling advancements in the evolving landscape of advanced heart failure management.
Collapse
Affiliation(s)
- Valeria Pergola
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35128 Padova, Italy; (G.M.); (F.A.); (M.P.M.); (S.I.)
| | - Matteo Cameli
- Department of Cardiovascular Diseases, University of Sienna, 53100 Siena, Italy; (M.C.); (M.C.P.)
| | - Giulia Mattesi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35128 Padova, Italy; (G.M.); (F.A.); (M.P.M.); (S.I.)
| | - Saima Mushtaq
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (S.M.); (C.M.D.); (G.P.)
| | | | - Andrea Igoren Guaricci
- University Cardiology Unit, Interdisciplinary Department of Medicine, Policlinic University Hospital, 70121 Bari, Italy;
| | - Maria Concetta Pastore
- Department of Cardiovascular Diseases, University of Sienna, 53100 Siena, Italy; (M.C.); (M.C.P.)
| | - Filippo Amato
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35128 Padova, Italy; (G.M.); (F.A.); (M.P.M.); (S.I.)
| | - Carlo Maria Dellino
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (S.M.); (C.M.D.); (G.P.)
| | - Raffaella Motta
- Unit of Radiology, Department of Medicine, Medical School, University of Padua, 35122 Padua, Italy;
| | - Martina Perazzolo Marra
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35128 Padova, Italy; (G.M.); (F.A.); (M.P.M.); (S.I.)
| | - Santo Dellegrottaglie
- Division of Cardiology, Ospedale Medico-Chirurgico Accreditato Villa dei Fiori, 80011 Acerra, Italy;
| | - Roberto Pedrinelli
- Cardiac, Thoracic and Vascular Department, University of Pisa, 56126 Pisa, Italy;
| | - Sabino Iliceto
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35128 Padova, Italy; (G.M.); (F.A.); (M.P.M.); (S.I.)
| | - Savina Nodari
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Institute of Cardiology, University of Brescia, 25123 Brescia, Italy;
| | - Pasquale Perrone Filardi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, 80138 Naples, Italy;
| | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (S.M.); (C.M.D.); (G.P.)
- Department of Biomedical, Surgical and Sciences, University of Milan, 20122 Milan, Italy
| | | |
Collapse
|
3
|
Sheng C, Yang C, Cheng Y, Li YM. Current status of diagnosis and treatment of primary benign cardiac tumors in children. Front Cardiovasc Med 2022; 9:947716. [PMID: 36337871 PMCID: PMC9635942 DOI: 10.3389/fcvm.2022.947716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 10/05/2022] [Indexed: 11/20/2022] Open
Abstract
Primary cardiac tumors in children are exceedingly rare overall, which benign account for most part. The onset of the disease is occult, while the clinical manifestations are non-specific-patients may be asymptomatic or show a range of obstructive, arrhythmic, embolic or systemic symptoms. The clinical presentations generally depend on the tumors’ size, localization, and pace of growth of the tumor. Moreover, the diagnosis needs comprehensive judgment based on imaging results and pathological examination. With advances in cardiac imagining and the introduction of cardiopulmonary support, the diagnosis and treatment of these rare tumors have improved the prognosis and outlook for benign tumors. To sum up the above, we sought to integrate articles from recent years for the latest comprehensive review of the clinical manifestations, imaging characteristics, clinic pathologic features and treatment of benign cardiac tumors in children to provide a broader idea for pediatricians to recognize and treat such diseases.
Collapse
|
4
|
Papachristidis A, Queirós S, Theodoropoulos KC, D'hooge J, Rafter P, Masoero G, Zidros S, Pagnano G, Huang M, Dancy L, Sado D, Shah AM, Murgatroyd FD, Monaghan MJ. The Impact of Vendor-Specific Ultrasound Beam-Forming and Processing Techniques on the Visualization of In Vitro Experimental "Scar": Implications for Myocardial Scar Imaging Using Two-Dimensional and Three-Dimensional Echocardiography. J Am Soc Echocardiogr 2021; 34:1095-1105.e6. [PMID: 34082020 DOI: 10.1016/j.echo.2021.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 05/16/2021] [Accepted: 05/17/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Myocardial scar appears brighter compared with normal myocardium on echocardiography because of differences in tissue characteristics. The aim of this study was to test how different ultrasound pulse characteristics affect the brightness contrast (i.e., contrast ratio [CR]) between tissues of different acoustic properties, as well as the accuracy of assessing tissue volume. METHODS An experimental in vitro "scar" model was created using overheated and raw pieces of commercially available bovine muscle. Two-dimensional and three-dimensional ultrasound scanning of the model was performed using combinations of ultrasound pulse characteristics: ultrasound frequency, harmonics, pulse amplitude, steady pulse (SP) emission, power modulation (PM), and pulse inversion modalities. RESULTS On both two-dimensional and three-dimensional imaging, the CR between the "scar" and its adjacent tissue was higher when PM was used. PM, as well as SP ultrasound imaging, provided good "scar" volume quantification. When tested on 10 "scars" of different size and shape, PM resulted in lower bias (-9.7 vs 54.2 mm3) and narrower limits of agreement (-168.6 to 149.2 mm3 vs -296.0 to 404.4 mm3, P = .03). The interobserver variability for "scar" volume was better with PM (intraclass correlation coefficient = 0.901 vs 0.815). Two-dimensional and three-dimensional echocardiography with PM and SP was performed on 15 individuals with myocardial scar secondary to infarction. The CR was higher on PM imaging. Using cardiac magnetic resonance as a reference, quantification of myocardial scar volume showed better agreement when PM was used (bias, -645 mm3; limits of agreement, -3,158 to 1,868 mm3) as opposed to SP (bias, -1,138 mm3; limits of agreement, -5,510 to 3,233 mm3). CONCLUSIONS The PM modality increased the CR between tissues with different acoustic properties in an experimental in vitro "scar" model while allowing accurate quantification of "scar" volume. By applying the in vitro findings to humans, PM resulted in higher CR between scarred and healthy myocardium, providing better scar volume quantification than SP compared with cardiac magnetic resonance.
Collapse
Affiliation(s)
- Alexandros Papachristidis
- Cardiology Department, King's College Hospital, London, United Kingdom; King's College London, British Heart Foundation Centre, London, United Kingdom.
| | - Sandro Queirós
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal; Lab on Cardiovascular Imaging and Dynamics, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | | | - Jan D'hooge
- Lab on Cardiovascular Imaging and Dynamics, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | | | - Giovanni Masoero
- Cardiology Department, King's College Hospital, London, United Kingdom
| | - Spyridon Zidros
- Cardiology Department, King's College Hospital, London, United Kingdom
| | - Gianpiero Pagnano
- Cardiology Department, King's College Hospital, London, United Kingdom
| | - Marilou Huang
- Cardiology Department, King's College Hospital, London, United Kingdom
| | - Luke Dancy
- Cardiology Department, King's College Hospital, London, United Kingdom; King's College London, British Heart Foundation Centre, London, United Kingdom
| | - Daniel Sado
- Cardiology Department, King's College Hospital, London, United Kingdom; King's College London, British Heart Foundation Centre, London, United Kingdom
| | - Ajay M Shah
- Cardiology Department, King's College Hospital, London, United Kingdom; King's College London, British Heart Foundation Centre, London, United Kingdom
| | - Francis D Murgatroyd
- Cardiology Department, King's College Hospital, London, United Kingdom; King's College London, British Heart Foundation Centre, London, United Kingdom
| | - Mark J Monaghan
- Cardiology Department, King's College Hospital, London, United Kingdom; King's College London, British Heart Foundation Centre, London, United Kingdom
| |
Collapse
|
5
|
Optimizing contrast-enhanced echocardiography by employing a sonographer driven protocol. J Echocardiogr 2021; 19:173-178. [PMID: 33797745 PMCID: PMC8352799 DOI: 10.1007/s12574-021-00523-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 03/04/2021] [Accepted: 03/13/2021] [Indexed: 11/11/2022]
Abstract
Background The use of enhancing agents in echocardiography has been shown to facilitate improved study quality. Despite the known benefits, its use remains limited by institutional policies. Methods We aimed to retrospectively evaluate if allowing sonographers to place a peripheral intravenous catheter and administer enhancing agent led to a decrease in time to complete outpatient transthoracic echocardiograms in comparison to using nursing personnel. Three separate protocols were employed. The ‘nurse driven protocol’ utilized nurses to place a peripheral intravenous catheter and inject enhancing agent. In a ‘mixed protocol,’ a nurse placed a peripheral intravenous catheter and the sonographer gave the enhancing agent. The ‘sonographer driven protocol’ involved the sonographer placing the peripheral intravenous catheter and delivering enhancing agent. Results A total of 232 echocardiograms were included for analysis. Patient characteristics across the three protocols were not statistically significant. The ‘mixed protocol’ had an average study time that was significantly less than the ‘nurse driven protocol’ (49.4 min ± 11.4 vs 54.6 min ± 12.9; p = 0.024). The ‘sonographer driven protocol’ also showed a significant reduction in study time (50.3 min ± 12.6) when compared to the ‘nurse driven protocol’ (p = 0.017). The additional task for the sonographer to place the peripheral intravenous catheter did not significantly increase the time to complete the study. Conclusion Allowing sonographers to administer enhancing agent reduced individual echocardiogram study times by approximately 5 min, supporting that a ‘sonographer driven protocol’ is more efficient with potential downstream economic benefits.
Collapse
|
6
|
Qiu Q, Abdelghany M, Subedi R, Scalzetti E, Feiglin D, Wang J, Liu K. Discrepant myocardial microvascular perfusion and mechanics after acute myocardial infarction: Characterization of the "Tako-tsubo effect" with real-time myocardial perfusion contrast echocardiograph. Int J Cardiol 2018; 276:1-7. [PMID: 30413307 DOI: 10.1016/j.ijcard.2018.09.114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 08/11/2018] [Accepted: 09/28/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND In patients with acute anterior myocardial infarction (MI), sometimes an "apical ballooning" contractile dysfunction pattern that exceeds factual myocardial injury is identified in the ventriculography and bedside echocardiography. The hemodynamic consequences/sequela of this "Tako-tsobu effect" has not been well delineated. Of note, this anatomic imaging finding often misleads frontline physicians who assume reciprocal causation of persistent cardiac pump failure and ventricular pressure overload. METHODS AND RESULTS Using real-time myocardial perfusion contrast echocardiography (MCE), we investigated myocardial (microvascular) perfusion in 60 patients after acute MI and coronary revascularization. Twenty-eight percent of the studied patients showed significantly mismatched myocardial perfusion and contractile defects. In these patients, an integrated imaging assessment with coronary angiography/ventriculography, deformation echocardiography, and MCE proved that the myocardial mechanic abnormalities significantly exceeded the defected perfusion areas. Compared with 72% of the patients without perfusion-contractility mismatch, apparently worse systolic functions (left ventricular ejection, wall motion score, and systolic longitudinal strain) in these patients did not change diastolic ventricular filling pressures (E/E' and E/A) or hemodynamic consequences/adverse events. Both systolic and diastolic functions in patients with perfusion-contractility mismatch appeared to be comparable with those in patients with Tako-tsubo syndrome. CONCLUSIONS Real-time MCE identifies discrepant myocardial microvascular perfusion and mechanics in patients with acute MI. The "Tako-tsubo effect" in patients with perfusion-contractility mismatch does not cause diastolic filling pressure change or worse hemodynamic consequence/cardiac event.
Collapse
Affiliation(s)
- Qiong Qiu
- Division of Cardiology, State University of New York, Upstate Medical University, Syracuse, NY 13202, United States of America; Division of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510120, China
| | - Mahmoud Abdelghany
- Division of Cardiology, State University of New York, Upstate Medical University, Syracuse, NY 13202, United States of America
| | - Rogin Subedi
- Division of Cardiology, State University of New York, Upstate Medical University, Syracuse, NY 13202, United States of America
| | - Ernest Scalzetti
- Department of Radiology, State University of New York, Upstate Medical University, Syracuse, NY 13202, United States of America
| | - David Feiglin
- Department of Radiology, State University of New York, Upstate Medical University, Syracuse, NY 13202, United States of America
| | - Jingfeng Wang
- Division of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510120, China.
| | - Kan Liu
- Division of Cardiology, State University of New York, Upstate Medical University, Syracuse, NY 13202, United States of America.
| |
Collapse
|
7
|
Pi S, Liu Y, Li T, Peng W, Wang D, Huang L, Kang N. Added value of contrast echocardiography in characterization of nonischemic cardiomyopathy. J Int Med Res 2018; 46:4813-4820. [PMID: 30213225 PMCID: PMC6259393 DOI: 10.1177/0300060518798525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Nonischemic cardiomyopathy (NICM) is a group of noncoronary heterogonous myocardial diseases. The heterogonous nature of NICM has impeded its diagnosis. In the present case series, we demonstrate the added value of using contrast echocardiography in the characterization of NICM. Two patients of advanced age were admitted for possible acute coronary syndrome, which was subsequently excluded by coronary angiography. Conventional and contrast echocardiography revealed characteristic structural and dynamic features of the left ventricle that were compatible with two distinct NICM diseases: stress-induced cardiomyopathy and noncompaction of the ventricular myocardium. Contrast echocardiography characterizes the cardiac structure and allows for real-time assessment of myocardial motion and perfusion. It may help to distinguish diseases with different etiologies.
Collapse
Affiliation(s)
- Shufang Pi
- 1 Heart Center, Third Central Hospital of Tianjin, Tianjin, China.,3 Tianjin Institute of Hepatobiliary Disease, Tianjin, China.,4 Tianjin Key Laboratory of Artificial Cell, Tianjin, China.,5 Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin, China
| | - Yingwu Liu
- 1 Heart Center, Third Central Hospital of Tianjin, Tianjin, China.,3 Tianjin Institute of Hepatobiliary Disease, Tianjin, China.,4 Tianjin Key Laboratory of Artificial Cell, Tianjin, China.,5 Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin, China
| | - Tong Li
- 1 Heart Center, Third Central Hospital of Tianjin, Tianjin, China.,3 Tianjin Institute of Hepatobiliary Disease, Tianjin, China.,4 Tianjin Key Laboratory of Artificial Cell, Tianjin, China.,5 Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin, China
| | - Wenjin Peng
- 1 Heart Center, Third Central Hospital of Tianjin, Tianjin, China.,3 Tianjin Institute of Hepatobiliary Disease, Tianjin, China.,4 Tianjin Key Laboratory of Artificial Cell, Tianjin, China.,5 Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin, China
| | - Dong Wang
- 2 Department of Ultrasonography, Third Central Hospital of Tianjin, Tianjin, China.,3 Tianjin Institute of Hepatobiliary Disease, Tianjin, China.,4 Tianjin Key Laboratory of Artificial Cell, Tianjin, China.,5 Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin, China
| | - Lei Huang
- 1 Heart Center, Third Central Hospital of Tianjin, Tianjin, China.,3 Tianjin Institute of Hepatobiliary Disease, Tianjin, China.,4 Tianjin Key Laboratory of Artificial Cell, Tianjin, China.,5 Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin, China
| | - Ningdong Kang
- 6 The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, Baltimore, MD, USA
| |
Collapse
|
8
|
Dave JK, Mc Donald ME, Mehrotra P, Kohut AR, Eisenbrey JR, Forsberg F. Recent technological advancements in cardiac ultrasound imaging. ULTRASONICS 2018; 84:329-340. [PMID: 29223692 PMCID: PMC5808891 DOI: 10.1016/j.ultras.2017.11.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 10/27/2017] [Accepted: 11/20/2017] [Indexed: 05/07/2023]
Abstract
About 92.1 million Americans suffer from at least one type of cardiovascular disease. Worldwide, cardiovascular diseases are the number one cause of death (about 31% of all global deaths). Recent technological advancements in cardiac ultrasound imaging are expected to aid in the clinical diagnosis of many cardiovascular diseases. This article provides an overview of such recent technological advancements, specifically focusing on tissue Doppler imaging, strain imaging, contrast echocardiography, 3D echocardiography, point-of-care echocardiography, 3D volumetric flow assessments, and elastography. With these advancements ultrasound imaging is rapidly changing the domain of cardiac imaging. The advantages offered by ultrasound imaging include real-time imaging, imaging at patient bed-side, cost-effectiveness and ionizing-radiation-free imaging. Along with these advantages, the steps taken towards standardization of ultrasound based quantitative markers, reviewed here, will play a major role in addressing the healthcare burden associated with cardiovascular diseases.
Collapse
Affiliation(s)
- Jaydev K Dave
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107, USA.
| | - Maureen E Mc Donald
- Department of Radiologic Sciences, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Praveen Mehrotra
- Division of Cardiology, Department of Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Andrew R Kohut
- Division of Cardiology, Department of Medicine, Drexel University College of Medicine, Philadelphia, PA 19129, USA
| | - John R Eisenbrey
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Flemming Forsberg
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| |
Collapse
|
9
|
Abstract
Ultrasound contrast agents have unique acoustic properties that enable them to enhance the cardiac blood flow and thus are used broadly in modern echocardiography laboratories for salvage of nondiagnostic studies, improving accuracy and reducing variability even in the presence of adequate image quality. Contrast echocardiography is also used as an adjunctive technique when unenhanced echocardiography falls short in the differentiation of cardiac structural abnormalities such as cardiac masses. Ultrasound contrast agents are pure intravascular tracers. Development of innovative ultrasound imaging techniques has led to myocardial perfusion imaging with contrast echocardiography. Although currently an off-label indication, it has been shown that perfusion imaging with contrast echocardiography adds incremental value to stress echocardiography in the detection of coronary artery disease. Moreover, it can be used for assessment of myocardial viability. In this paper we briefly discuss the basics of contrast echocardiography and its use in daily clinical practice.
Collapse
|
10
|
Erbel R. Echokardiographie. Herz 2017; 42:229-231. [DOI: 10.1007/s00059-017-4557-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
11
|
Karogiannis N, Senior R. Contrast echocardiography for detection of myocardial perfusion abnormalities. Herz 2017; 42:287-294. [DOI: 10.1007/s00059-017-4536-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
12
|
Miller DL, Lu X, Fabiilli M, Fields K, Dou C. Frequency Dependence of Petechial Hemorrhage and Cardiomyocyte Injury Induced during Myocardial Contrast Echocardiography. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:1929-41. [PMID: 27126240 PMCID: PMC4912900 DOI: 10.1016/j.ultrasmedbio.2016.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 03/15/2016] [Accepted: 03/20/2016] [Indexed: 05/24/2023]
Abstract
Myocardial contrast echocardiography (MCE) for perfusion imaging can induce microscale bio-effects during intermittent high-Mechanical Index scans. The dependence of MCE-induced bio-effects on the ultrasonic frequency was examined in rats at 1.6, 2.5 and 3.5 MHz. Premature complexes were counted in the electrocardiogram, petechial hemorrhages with microvascular leakage on the heart surface were observed at the time of exposure, plasma troponin elevation was measured after 4 h and cardiomyocyte injury was detected at 24 h. Increasing response to exposure above an apparent threshold was observed for all endpoints at each frequency. The effects decreased with increasing ultrasonic frequency, and the thresholds increased. Linear regressions for frequency-dependent thresholds indicated coefficients and exponents of 0.6 and 1.07 for petechial hemorrhages, respectively, and 1.02 and 0.8 for cardiomyocyte death, compared with 1.9 and 0.5 (square root) for the guideline limit of the mechanical index. The results clarify the dependence of cardiac bio-effects on frequency, and should allow development of theoretical descriptions of the phenomena and improved safety guidance for MCE.
Collapse
Affiliation(s)
- Douglas L Miller
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA.
| | - Xiaofang Lu
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Mario Fabiilli
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Kristina Fields
- Department of Pathology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Chunyan Dou
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| |
Collapse
|
13
|
Appis AW, Tracy MJ, Feinstein SB. Update on the safety and efficacy of commercial ultrasound contrast agents in cardiac applications. Echo Res Pract 2015; 2:R55-62. [PMID: 26693339 PMCID: PMC4676450 DOI: 10.1530/erp-15-0018] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 04/22/2015] [Indexed: 12/27/2022] Open
Abstract
Ultrasound contrast agents (UCAs) are currently used throughout the world in both clinical and research settings. The concept of contrast-enhanced ultrasound imaging originated in the late 1960s, and the first commercially available agents were initially developed in the 1980s. Today's microbubbles are designed for greater utility and are used for both approved and off-label indications. In October 2007, the US Food and Drug Administration (FDA) imposed additional product label warnings that included serious cardiopulmonary reactions, several new disease-state contraindications, and a mandated 30 min post-procedure monitoring period for the agents Optison and Definity. These additional warnings were prompted by reports of cardiopulmonary reactions that were temporally related but were not clearly attributable to these UCAs. Subsequent published reports over the following months established not only the safety but also the improved efficacy of clinical ultrasound applications with UCAs. The FDA consequently updated the product labeling in June 2008 and reduced contraindications, although it continued to monitor select patients. In addition, a post-marketing program was proposed to the sponsors for a series of safety studies to further assess the risk of UCAs. Then in October 2011, the FDA leadership further downgraded the warnings after hearing the results of the post-marketing data, which revealed continued safety and improved efficacy. The present review focuses on the use of UCAs in today's clinical practice, including the approved indications, a variety of off-label uses, and the most recent data, which affirms the safety and efficacy of UCAs.
Collapse
Affiliation(s)
- Andrew W Appis
- Division of Cardiology, Rush University Medical Center , 1653 West Congress Parkway, Chicago, Illinois, 60612 , USA
| | - Melissa J Tracy
- Division of Cardiology, Rush University Medical Center , 1653 West Congress Parkway, Chicago, Illinois, 60612 , USA
| | - Steven B Feinstein
- Division of Cardiology, Rush University Medical Center , 1653 West Congress Parkway, Chicago, Illinois, 60612 , USA
| |
Collapse
|
14
|
Abstract
The rdar morphotype, a multicellular behaviour of Salmonella enterica and Escherichia coli is characterized by the expression of the adhesive extracellular matrix components cellulose and curli fimbriae. The response regulator CsgD, which transcriptionally activates the biosynthesis of the exopolysaccharide cellulose and curli, also transforms cell physiology to the multicellular state. However, the only role of CsgD in cellulose biosynthesis is the activation of AdrA, a GGDEF domain protein that mediates production of the allosteric activator cyclic-di-(3'-5')guanylic acid (c-di-GMP). In S. enterica serovar Typhimurium a regulatory network consisting of 19 GGDEF/EAL domain-containing proteins tightly controls the concentration of c-di-GMP. c-di-GMP not only regulates the expression of cellulose, but also stimulates expression of adhesive curli and represses various modes of motility. Functions of characterized GGDEF and EAL domain proteins, as well as database searches, point to a global role for c-di-GMP as a novel secondary messenger that regulates a variety of cellular functions in response to diverse environmental stimuli already in the deepest roots of the prokaryotes.
Collapse
Affiliation(s)
- U Römling
- Microbiology and Tumor Biology Center, Karolinska Institutet, Box 280, 17177 Stockholm, Sweden.
| |
Collapse
|