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Capdeville S, Gholson BA, Lindner JR. Contrast Echocardiography for Assessing Myocardial Perfusion. Curr Cardiol Rep 2023; 25:1581-1587. [PMID: 37787859 DOI: 10.1007/s11886-023-01970-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE OF REVIEW Improvements in ultrasound methods for detecting microbubble ultrasound enhancing agents have led to an increase in the use of perfusion imaging with myocardial contrast echocardiography (MCE). This technique is now beginning to play an important role in specific clinical scenarios, which is the focus of this review. RECENT FINDINGS MCE was originally conceived as a technique for detecting resting perfusion abnormalities related to ischemia at rest or during stress from coronary artery disease. More recently, MCE has increasingly been used in circumstances where the technique's ability to provide rapid, quantitative, or bedside assessment of perfusion is advantageous. Quantitative MCE is also increasingly being used as a research technique for evaluating pathobiology and therapy that involve changes in the myocardial microcirculation. While MCE was developed and validated decades ago, it is only now beginning to be used by an increasing number of clinicians due to improvements in imaging technology and recognition of specific situations where the technique is impactful.
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Affiliation(s)
- Sofia Capdeville
- Division of Cardiovascular Medicine and Robert M. Berne Cardiovascular Research Center, University of Virginia, 415 Lane Rd, Box 801394, Charlottesville, VA, 22903, USA
| | - Bethany A Gholson
- Division of Cardiovascular Medicine and Robert M. Berne Cardiovascular Research Center, University of Virginia, 415 Lane Rd, Box 801394, Charlottesville, VA, 22903, USA
| | - Jonathan R Lindner
- Division of Cardiovascular Medicine and Robert M. Berne Cardiovascular Research Center, University of Virginia, 415 Lane Rd, Box 801394, Charlottesville, VA, 22903, USA.
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2
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Ndrepepa G, Kastrati A. Coronary No-Reflow after Primary Percutaneous Coronary Intervention-Current Knowledge on Pathophysiology, Diagnosis, Clinical Impact and Therapy. J Clin Med 2023; 12:5592. [PMID: 37685660 PMCID: PMC10488607 DOI: 10.3390/jcm12175592] [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: 07/10/2023] [Revised: 08/17/2023] [Accepted: 08/26/2023] [Indexed: 09/10/2023] Open
Abstract
Coronary no-reflow (CNR) is a frequent phenomenon that develops in patients with ST-segment elevation myocardial infarction (STEMI) following reperfusion therapy. CNR is highly dynamic, develops gradually (over hours) and persists for days to weeks after reperfusion. Microvascular obstruction (MVO) developing as a consequence of myocardial ischemia, distal embolization and reperfusion-related injury is the main pathophysiological mechanism of CNR. The frequency of CNR or MVO after primary PCI differs widely depending on the sensitivity of the tools used for diagnosis and timing of examination. Coronary angiography is readily available and most convenient to diagnose CNR but it is highly conservative and underestimates the true frequency of CNR. Cardiac magnetic resonance (CMR) imaging is the most sensitive method to diagnose MVO and CNR that provides information on the presence, localization and extent of MVO. CMR imaging detects intramyocardial hemorrhage and accurately estimates the infarct size. MVO and CNR markedly negate the benefits of reperfusion therapy and contribute to poor clinical outcomes including adverse remodeling of left ventricle, worsening or new congestive heart failure and reduced survival. Despite extensive research and the use of therapies that target almost all known pathophysiological mechanisms of CNR, no therapy has been found that prevents or reverses CNR and provides consistent clinical benefit in patients with STEMI undergoing reperfusion. Currently, the prevention or alleviation of MVO and CNR remain unmet goals in the therapy of STEMI that continue to be under intense research.
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Affiliation(s)
- Gjin Ndrepepa
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636 Munich, Germany;
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636 Munich, Germany;
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 80336 Munich, Germany
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3
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Flachskampf FA, Baron T. The Role of Novel Cardiac Imaging for Contemporary Management of Heart Failure. J Clin Med 2022; 11:6201. [PMID: 36294522 PMCID: PMC9605302 DOI: 10.3390/jcm11206201] [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: 09/08/2022] [Revised: 10/10/2022] [Accepted: 10/16/2022] [Indexed: 11/26/2022] Open
Abstract
Heart failure is becoming the central problem in cardiology. Its recognition, differential diagnosis, and the monitoring of therapy are intimately coupled with cardiac imaging. Cardiac imaging has witnessed an explosive growth and differentiation, with echocardiography continuing as the first diagnostic step; the echocardiographic exam itself has become considerably more complex than in the last century, with the assessment of diastolic left ventricular function and strain imaging contributing important information, especially in heart failure. Very often, however, echocardiography can only describe the fact of functional impairment and morphologic remodeling, whereas further clarification of the underlying disease, such as cardiomyopathy, myocarditis, storage diseases, sarcoidosis, and others, remains elusive. Here, cardiovascular magnetic resonance and perfusion imaging should be used judiciously to arrive as often as possible at a clear diagnosis which ideally enables specific therapy.
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Affiliation(s)
- Frank A. Flachskampf
- Department of Medical Sciences, Cardiology and Clinical Physiology, Uppsala University Hospital, Uppsala University, 751 85 Uppsala, Sweden
| | - Tomasz Baron
- Department of Medical Sciences, Cardiology and Clinical Physiology, Uppsala University Hospital, Uppsala University, 751 85 Uppsala, Sweden
- Uppsala Clinical Research Center, Uppsala University, 752 36 Uppsala, Sweden
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4
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Zhan J, Zhong L, Wu J. Assessment and Treatment for Coronary Microvascular Dysfunction by Contrast Enhanced Ultrasound. Front Cardiovasc Med 2022; 9:899099. [PMID: 35795368 PMCID: PMC9251174 DOI: 10.3389/fcvm.2022.899099] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/26/2022] [Indexed: 11/17/2022] Open
Abstract
With growing evidence in clinical practice, the understanding of coronary syndromes has gradually evolved out of focusing on the well-established link between stenosis of epicardial coronary artery and myocardial ischemia to the structural and functional abnormalities at the level of coronary microcirculation, known as coronary microvascular dysfunction (CMD). CMD encompasses several pathophysiological mechanisms of coronary microcirculation and is considered as an important cause of myocardial ischemia in patients with angina symptoms without obstructive coronary artery disease (CAD). As a result of growing knowledge of the understanding of CMD assessed by multiple non-invasive modalities, CMD has also been found to be involved in other cardiovascular diseases, including primary cardiomyopathies as well as heart failure with preserved ejection fraction (HFpEF). In the past 2 decades, almost all the imaging modalities have been used to non-invasively quantify myocardial blood flow (MBF) and promote a better understanding of CMD. Myocardial contrast echocardiography (MCE) is a breakthrough as a non-invasive technique, which enables assessment of myocardial perfusion and quantification of MBF, exhibiting promising diagnostic performances that were comparable to other non-invasive techniques. With unique advantages over other non-invasive techniques, MCE has gradually developed into a novel modality for assessment of the coronary microvasculature, which may provide novel insights into the pathophysiological role of CMD in different clinical conditions. Moreover, the sonothrombolysis and the application of artificial intelligence (AI) will offer the opportunity to extend the use of contrast ultrasound theragnostics.
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5
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Reid A, Dweck MR. Let there be light! The meteoric rise of cardiac imaging. BRITISH HEART JOURNAL 2022; 108:780-786. [PMID: 35459728 DOI: 10.1136/heartjnl-2021-320147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/02/2022] [Indexed: 11/04/2022]
Abstract
Imaging plays a central role in modern cardiovascular practice. It is a field characterised by exciting technological advances that have shaped our understanding of pathology and led to major improvements in patient diagnosis and care. The UK has played a key international role in the development of this subspecialty and is the current home to many of the leading global centres in multimodality cardiovascular imaging. In this short review, we will outline some of the key contributions of the British Cardiovascular Society and its members to this rapidly evolving field and look at how this relationship may continue to shape future cardiovascular practice.
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Affiliation(s)
- Anna Reid
- Department of Cardiology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Marc Richard Dweck
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
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6
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Lindner JR. Contrast echocardiography: current status and future directions. Heart 2020; 107:18-24. [PMID: 33077502 DOI: 10.1136/heartjnl-2020-316662] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/04/2020] [Accepted: 09/21/2020] [Indexed: 12/17/2022] Open
Abstract
Contrast echocardiography is a family of ultrasound-based procedures, whereby acoustic enhancing agents, usually microbubbles, are administered by intravenous route and detected in order to improve diagnostic performance. This review describes: (1) the agents that have been designed for diagnostic imaging, (2) current clinical applications where either left ventricular opacification or microvascular perfusion imaging with myocardial contrast echocardiography have been demonstrated to provide incremental information to non-contrast echocardiography and (3) future diagnostic and therapeutic applications of contrast ultrasound that rely on unique compositional design of ultrasound-enhancing agents.
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Affiliation(s)
- Jonathan R Lindner
- Division of Cardiovascular Medicine, Oregon Health & Science University, Portland, Oregon, USA
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7
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Siniscalchi C, Gaibazzi N. Contrast stress-echocardiography compared with single photon emission computed tomography to detect multivessel coronary artery disease. Acta Cardiol 2019; 74:287-289. [PMID: 30507298 DOI: 10.1080/00015385.2018.1515298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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8
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Mao S, Xu DP, Dang XJ, Li W, Wu HL. Shenzhu Guanxin Recipe Granules () for Improving Exercise Tolerance in Patients with Stable Angina (SERIES Trial): A Protocol of Multicenter, Randomized, Double-Blind, Placebo Parallel Controlled Clinical Trial. Chin J Integr Med 2018; 25:96-102. [PMID: 30328569 DOI: 10.1007/s11655-018-3017-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Many patients with chronic angina experience anginal episodes despite successful recanalization, antianginal and antiischemic medications. Empirical observations suggested that Shenzhu Guanxin Recipe Granules (, SGR), a Chinese herbal compound, exerted potential impacts on increased treadmill exercise performance and angina relieve. However, there has been no systematic study to clarify the impact of SGR on exercise tolerance in patients with stable angina. The SERIES (ShEnzhu guanxin Recipe for Improving Exercise tolerance in patients with Stable angina) trial is designed to determine the effects of SGR on exercise duration, electrocardiographic (ECG) evidence of myocardial ischemia, and incidence of major adverse cardiac events (MACE) in stable anginal patients. METHODS A total of 184 eligible patients with stable angina will be randomly assigned to receive placebo or SGR (10 g/day for 12 weeks) in a 1:1 ratio. The primary outcome will be the change from baseline in total exercise tolerance duration, time to onset of angina and ECG ischemia during exercise treadmill testing performed over a 12-week study period. The secondary outcome will include ECG measures, the occurrence and composite of MACE and the Seattle Angina Questionnaire score. Moreover, the coronary microcirculation will be evaluated to explore the possible effects in response to treatment of SGR. After the procedure, all participants will be followed up by interview at 3 and 6 months, enquiring about any cardiac events, hospitalizations, cardiac functional level and medication usage. Additionally, the occurrence of adverse events will be evaluated at each follow-up. DISCUSSION This study may provide novel evidence on the efficacy of SGR in improving exercise tolerance and potentially reducing clinical adverse events. (Trial registration No. ChiCTR-TRC-14004504).
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Affiliation(s)
- Shuai Mao
- Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China.,Heart Center, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
| | - Dan-Ping Xu
- Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China.,Heart Center, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
| | - Xiao-Jing Dang
- Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China.,Heart Center, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
| | - Winny Li
- Faculty of Medicine, University of Toronto, Toronto, M5G 0A4, Canada
| | - Huan-Lin Wu
- Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China. .,Heart Center, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China. .,Beijing University of Chinese Medicine, Beijing, 100029, China.
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9
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Senior R, Becher H, Monaghan M, Agati L, Zamorano J, Vanoverschelde JL, Nihoyannopoulos P, Edvardsen T, Lancellotti P. Clinical practice of contrast echocardiography: recommendation by the European Association of Cardiovascular Imaging (EACVI) 2017. Eur Heart J Cardiovasc Imaging 2018; 18:1205-1205af. [PMID: 28950366 DOI: 10.1093/ehjci/jex182] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 06/20/2017] [Indexed: 12/16/2022] Open
Abstract
Contrast echocardiography is widely used in cardiology. It is applied to improve image quality, reader confidence and reproducibility both for assessing left ventricular (LV) structure and function at rest and for assessing global and regional function in stress echocardiography. The use of contrast in echocardiography has now extended beyond cardiac structure and function assessment to evaluation of perfusion both of the myocardium and of the intracardiac structures. Safety of contrast agents have now been addressed in large patient population and these studies clearly established its excellent safety profile. This document, based on clinical trials, randomized and multicentre studies and published clinical experience, has established clear recommendations for the use of contrast in various clinical conditions with evidence-based protocols.
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Affiliation(s)
- Roxy Senior
- Department of Cardiology, Royal Brompton Hospital, Imperial College, Sydney Street, London SW3 6NP, UK
| | | | | | | | - Jose Zamorano
- CIBERCV, University Hospital Ramón y Cajal, Madrid, Spain
| | | | | | | | - Patrizio Lancellotti
- University of Liege Hospital, GIGA Cardiovascular Science, Heart Valve Clinic, Imaging Cardiology, Liege, Belgium
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10
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Shah BN, MacNab A, Lynch J, Hampson R, Senior R, Steeds RP. Stress echocardiography in contemporary clinical cardiology: practical considerations and accreditation. Echo Res Pract 2018; 5:E1-E6. [PMID: 29358185 PMCID: PMC5795358 DOI: 10.1530/erp-17-0032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 01/09/2018] [Indexed: 11/20/2022] Open
Abstract
Stress echocardiography is a widely utilised test in patients with known or suspected coronary artery disease (CAD), valvular heart disease and cardiomyopathies. Its advantages include the ubiquitous availability of echocardiography, lack of ionising radiation, choice of physiological or pharmacological stressors, good diagnostic accuracy and robust supporting evidence base. SE has evolved significantly as a technique over the past three decades and has benefitted considerably from improvements in overall image quality (superior resolution), machine technology (e.g. digital cine-loop acquisition and side-by-side image display) and development of second-generation ultrasound contrast agents that have improved reader confidence and diagnostic accuracy. The purpose of this article is to review the breadth of SE in contemporary clinical cardiology and discuss the recently launched British Society of Echocardiography (BSE) Stress Echocardiography accreditation scheme.
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Affiliation(s)
- Benoy N Shah
- Wessex Cardiac CentreUniversity Hospital Southampton, Southampton, UK
| | - Anita MacNab
- University Hospital of South ManchesterManchester, UK
| | - Jane Lynch
- University Hospital of South ManchesterManchester, UK
| | | | - Roxy Senior
- Northwick Park HospitalHarrow, UK.,National Heart and Lung InstituteImperial College, London, UK
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11
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Guo Y, Du GQ, Xue JY, Xia R, Wang YH. A novel myocardium segmentation approach based on neutrosophic active contour model. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2017; 142:109-116. [PMID: 28325439 DOI: 10.1016/j.cmpb.2017.02.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 02/09/2017] [Accepted: 02/15/2017] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Automatic delineation of the myocardium in echocardiography can assist radiologists to diagnosis heart problems. However, it is still challenging to distinguish myocardium from other tissue due to a low signal-to-noise ratio, low contrast, vague boundary, and speckle noise. The purpose of this study is to automatically detect myocardium region in left ventricle myocardial contrast echocardiography (LVMCE) images to help radiologists' diagnosis and further measurement on infarction size. METHODS The LVMCE image is firstly mapped into neutrosophic similarity (NS) domain using the intensity and homogeneity features. Then, a neutrosophic active contour model (NACM) is proposed and the energy function is defined by the NS values. Finally, the ventricle is detected using the curve evolving results. The ventricle's boundary is identified as the endocardium. To speed up the evolution procedure and increase the detection accuracy, a clustering algorithm is employed to obtain the initial ventricle region. The curve evolution procedure in NACM is utilized again to obtain the epicardium, where the initial contour uses the detected endocardium and the anatomy knowledge on the thickness of the myocardium. RESULTS Echocardiographic studies are performed on 10 male Sprague-Dawley rats using a Vivid 7 system including 5 normal cases and 5 rats with myocardial infarction. The myocardium boundaries manually outlined by an experienced radiologist are used as the reference standard for the performance evaluation. Two metrics, Hdist and AvgDist, are employed to evaluate the detection results. The NACM method was compared with those from the eliminated particle swarm optimization (EPSO) and active contour model without edges (ACMWE) methods. The mean and standard deviation of the Hdist and AvgDist on endocardium are 6.83 ± 1.12mm and 0.79 ± 0.28mm using EPSO method, 7.12 ± 0.98mm and 0.82 ± 0.32mm using ACMWE method, and 4.55 ± 0.9mm and 0.58 ± 0.18mm using NACM method, respectively. The improvement on epicardium is much more significant, and two metrics are decreased from 7.45 ± 1.24mm, and 1.47 ± 0.34mm using EPSO method, and 8.21±0.43mm, and 1.73±0.47mm using ACMWE method, to 4.94 ± 0.82mm, and 0.84 ± 0.22mm using NACM method, respectively. CONCLUSIONS The proposed method can automatically detect myocardium accurately, and is helpful for clinical therapeutics to measure myocardial perfusion and infarct size.
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Affiliation(s)
- Yanhui Guo
- Department of Computer Science, University of Illinois at Springfield, Springfield, IL USA.
| | - Guo-Qing Du
- Department of Ultrasound, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jing-Yi Xue
- Department of Cardiology, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Rong Xia
- Oracle Corporation, Westminster, CO, USA
| | - Yu-Hang Wang
- Department of Ultrasound, Second Affiliated Hospital of Harbin Medical University, Harbin, China
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12
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Vamvakidou A, Karogiannis N, Tzalamouras V, Parsons G, Young G, Gurunathan S, Senior R. Prognostic usefulness of contemporary stress echocardiography in patients with left bundle branch block and impact of contrast use in improving prediction of outcome. Eur Heart J Cardiovasc Imaging 2017; 18:415-421. [PMID: 28013281 DOI: 10.1093/ehjci/jew211] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 08/30/2016] [Indexed: 01/09/2023] Open
Abstract
Aims Patients with symptomatic left bundle branch block (LBBB) may have myocardial ischaemia due to both coronary artery disease and/or cardiomyopathy (microcirculatory abnormalities) and may have concomitant left ventricular (LV) dysfunction. We aimed to assess the feasibility and prognostic value of contemporary stress echocardiography (SE), which can uncover both pathophysiologies in LBBB patients in routine clinical practice, and also aimed to assess the additive value of contrast SE. Methods and results Accordingly, 190 consecutive patients (age 70.5 ± 11.3 years, LV ejection fraction = 50.1 ± 10%) with symptomatic LBBB who underwent SE over 6 years were assessed, of which 142 (75%) underwent contrast SE and 176 (92.6%) had diagnostic SE. Inducible ischaemia was present in 25 (14.2%) patients. During follow-up (35.4 ± 20.2 months) there were 32 deaths (18%) and 18 (10.2%) first cardiovascular (CV) events (acute myocardial infarction/mortality) in the 176 patients with diagnostic studies. Wall thickening score index at peak stress (WTSIpeak), which measures combined LV function and inducible ischaemia, was an independent predictor of mortality (HR = 3.78, 95% CI = 1.39-10.31, P = 0.01) and CV events (HR = 3.96, 95% CI = 1.1-14.3, P = 0.036). An abnormal SE (myocardial ischaemia and/or abnormal LV function) predicted an almost three-fold increase in all-cause mortality and CV events compared with normal SE. Amongst the confounders affecting assessment of wall thickening in LBBB and conventional prognostic variables, use of contrast was an independent predictor (P = 0.034) of WTSI1.16 (optimal predictor of mortality/CV outcome). Conclusion SE in patients with LBBB demonstrated high feasibility and the combination of LV systolic function and myocardial ischaemia provided important prognostic information. Contrast-enhanced SE improved the prediction of outcome.
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Affiliation(s)
- Anastasia Vamvakidou
- Department of Cardiovascular Medicine, Northwick Park Hospital, Watford Road, Harrow, HA1 3UJ, UK.,Department of Cardiology, Royal Brompton Hospital, London, UK.,Cardiovascular Biomedical Research Unit, National Heart and Lung Institute, Imperial College, London, UK
| | - Nikos Karogiannis
- Department of Cardiovascular Medicine, Northwick Park Hospital, Watford Road, Harrow, HA1 3UJ, UK
| | - Vasilis Tzalamouras
- Department of Cardiovascular Medicine, Northwick Park Hospital, Watford Road, Harrow, HA1 3UJ, UK
| | - Guy Parsons
- Department of Cardiovascular Medicine, Northwick Park Hospital, Watford Road, Harrow, HA1 3UJ, UK
| | - Grace Young
- Department of Cardiovascular Medicine, Northwick Park Hospital, Watford Road, Harrow, HA1 3UJ, UK
| | - Sothinathan Gurunathan
- Department of Cardiovascular Medicine, Northwick Park Hospital, Watford Road, Harrow, HA1 3UJ, UK.,Department of Cardiology, Royal Brompton Hospital, London, UK.,Cardiovascular Biomedical Research Unit, National Heart and Lung Institute, Imperial College, London, UK
| | - Roxy Senior
- Department of Cardiovascular Medicine, Northwick Park Hospital, Watford Road, Harrow, HA1 3UJ, UK.,Department of Cardiology, Royal Brompton Hospital, London, UK.,Cardiovascular Biomedical Research Unit, National Heart and Lung Institute, Imperial College, London, UK
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13
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Prognostic Value of Myocardial Perfusion Analysis in Patients with Coronary Artery Disease: A Meta-Analysis. J Am Soc Echocardiogr 2017; 30:270-281. [DOI: 10.1016/j.echo.2016.11.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Indexed: 01/28/2023]
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14
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Maier A, Opris MM, Sirbu V, Brinzaniuc K. Myocardial Contrast Agents – Safety Considerations and Clinical Efficacy in Stress Echocardiography. ARS MEDICA TOMITANA 2016. [DOI: 10.1515/arsm-2016-0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Transthoracic echocardiographic examination is known to be a safe, non-invasive and reproducible method, used in every day clinical practice to obtain important information about cardiac structure and function. Unfortunately, a significant proportion of studies have highlighted the considerable technically difficultly in producing diagnostic images due to a poor acoustic window and more than 33% of patients undergoing stress echocardiography have suboptimal echocardiographic images. All these limitations have led to the use of contrast agents to improve the quality of standard ultrasound examination to provide a better delineation of left ventricle endocardial borders or to obtain information that cannot be achieved by using standard echocardiography, such as assessing myocardial microcirculation and therefore perfusion. This paper sought to review the clinical efficacy and safety of ultrasound contrast agents focusing on stress echocardiography.
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Affiliation(s)
- Anca Maier
- University of Medicine and Pharmacy Tirgu Mures
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15
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Vamvakidou A, Gurunathan S, Senior R. Novel techniques in stress echocardiography: a focus on the advantages and disadvantages. Expert Rev Cardiovasc Ther 2016; 14:477-94. [DOI: 10.1586/14779072.2016.1135054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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16
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Zoppellaro G, Venneri L, Khattar RS, Li W, Senior R. Simultaneous Assessment of Myocardial Perfusion, Wall Motion, and Deformation during Myocardial Contrast Echocardiography: A Feasibility Study. Echocardiography 2016; 33:889-95. [PMID: 26833555 DOI: 10.1111/echo.13190] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
AIMS Ultrasound contrast agents may be used for the assessment of regional wall motion and myocardial perfusion, but are generally considered not suitable for deformation analysis. The aim of our study was to assess the feasibility of deformation imaging on contrast-enhanced images using a novel methodology. METHODS AND RESULTS We prospectively enrolled 40 patients who underwent stress echocardiography with continuous intravenous infusion of SonoVue for the assessment of myocardial perfusion imaging with flash replenishment technique. We compared longitudinal strain (Lε) values, assessed with a vendor-independent software (2D CPA), on 68 resting contrast-enhanced and 68 resting noncontrast recordings. Strain analysis on contrast recordings was evaluated in the first cardiac cycles after the flash. Tracking of contrast images was deemed feasible in all subjects and in all views. Contrast administration improved image quality and increased the number of segments used for deformation analysis. Lε of noncontrast and contrast-enhanced images were statistically different (-18.8 ± 4.5% and -22.8 ± 5.4%, respectively; P < 0.001), but their correlation was good (ICC 0.65, 95%CI 0.42-0.78). Patients with resting wall-motion abnormalities showed lower Lε values on contrast recordings (-18.6 ± 6.0% vs. -24.2 ± 5.5%, respectively; P < 0.01). Intra-operator and inter-operator reproducibility was good for both noncontrast and contrast images with no statistical differences. CONCLUSIONS Our study shows that deformation analysis on postflash contrast-enhanced images is feasible and reproducible. Therefore, it would be possible to perform a simultaneous evaluation of wall-motion abnormalities, volumes, ejection fraction, perfusion defects, and cardiac deformation on the same contrast recording.
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Affiliation(s)
- Giacomo Zoppellaro
- Department of Echocardiography, Royal Brompton Hospital, London, United Kingdom
| | - Lucia Venneri
- Department of Echocardiography, Royal Brompton Hospital, London, United Kingdom
| | - Rajdeep S Khattar
- Department of Echocardiography, Royal Brompton Hospital, London, United Kingdom.,Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom.,National Heart and Lung Institute (NHLI), Imperial College, London, United Kingdom
| | - Wei Li
- Department of Echocardiography, Royal Brompton Hospital, London, United Kingdom
| | - Roxy Senior
- Department of Echocardiography, Royal Brompton Hospital, London, United Kingdom.,Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom.,National Heart and Lung Institute (NHLI), Imperial College, London, United Kingdom
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Tweet MS, Arruda-Olson AM, Anavekar NS, Pellikka PA. Stress echocardiography: what is new and how does it compare with myocardial perfusion imaging and other modalities? Curr Cardiol Rep 2016; 17:43. [PMID: 25911442 DOI: 10.1007/s11886-015-0600-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Cardiovascular disease is a leading cause of morbidity and mortality, and noninvasive strategies to diagnose and risk stratify patients remain paramount in the evaluative process. Stress echocardiography is a well-established, versatile, real-time imaging modality with advantages including lack of radiation exposure, portability, and affordability. Innovative techniques in stress echocardiography include myocardial contrast echocardiography, deformation imaging, three-dimensional (3D) echocardiography, and assessment of coronary flow reserve. Myocardial perfusion imaging with single-photon emission computed tomography (SPECT) or positron emission tomography (PET) are imaging alternatives, and stress cardiac magnetic resonance imaging and coronary computed tomography (CT) angiography, including CT perfusion imaging, are emerging as newer approaches. This review will discuss recent and upcoming developments in the field of stress testing, with an emphasis on stress echocardiography while highlighting comparisons with other modalities.
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Affiliation(s)
- Marysia S Tweet
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA,
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Barletta G, Del Bene MR. Myocardial perfusion echocardiography and coronary microvascular dysfunction. World J Cardiol 2015; 7:861-874. [PMID: 26730291 PMCID: PMC4691812 DOI: 10.4330/wjc.v7.i12.861] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 09/04/2015] [Accepted: 10/19/2015] [Indexed: 02/07/2023] Open
Abstract
Our understanding of coronary syndromes has evolved in the last two decades out of the obstructive atherosclerosis of epicardial coronary arteries paradigm to include anatomo-functional abnormalities of coronary microcirculation. No current diagnostic technique allows direct visualization of coronary microcirculation, but functional assessments of this circulation are possible. This represents a challenge in cardiology. Myocardial contrast echocardiography (MCE) was a breakthrough in echocardiography several years ago that claimed the capability to detect myocardial perfusion abnormalities and quantify coronary blood flow. Research demonstrated that the integration of quantitative MCE and fractional flow reserve improved the definition of ischemic burden and the relative contribution of collaterals in non-critical coronary stenosis. MCE identified no-reflow and low-flow within and around myocardial infarction, respectively, and predicted the potential functional recovery of stunned myocardium using appropriate interventions. MCE exhibited diagnostic performances that were comparable to positron emission tomography in microvascular reserve and microvascular dysfunction in angina patients. Overall, MCE improved echocardiographic evaluations of ischemic heart disease in daily clinical practice, but the approval of regulatory authorities is lacking.
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The Incremental Prognostic Value of the Incorporation of Myocardial Perfusion Assessment into Clinical Testing with Stress Echocardiography Study. J Am Soc Echocardiogr 2015; 28:1358-65. [DOI: 10.1016/j.echo.2015.07.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Indexed: 01/08/2023]
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Abstract
Transthoracic echocardiography is the most widely used imaging test in cardiology. Although completely noninvasive, transthoracic echocardiography has a well-established role in the diagnosis of numerous cardiovascular diseases, and also provides critical qualitative and quantitative information on their prognosis and pathophysiological processes. The aim of this Review is to outline the broad principles of transthoracic echocardiography, including the traditional techniques of two-dimensional, colour, and spectral Doppler echocardiography, and newly developed advances including tissue Doppler, myocardial deformation imaging, torsion, stress echocardiography, contrast and three-dimensional echocardiography. The advantages and disadvantages, clinical application, prognostic value, and salient research findings of each modality are described. Advances in complex imaging techniques are expected to continue unabated, and this Review highlights technical improvements that will influence the diagnosis and improve our understanding of cardiovascular function and disease.
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Affiliation(s)
- Anita C Boyd
- South Western Sydney Clinical School, University of New South Wales, Liverpool Hospital, Corner Elizabeth/Goulburn Street, NSW 2170, Australia
| | - Nelson B Schiller
- University of California, 505 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Liza Thomas
- South Western Sydney Clinical School, University of New South Wales, Liverpool Hospital, Corner Elizabeth/Goulburn Street, NSW 2170, Australia
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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.
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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
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Mahía-Casado P, García-Orta R, Gómez de Diego JJ, Barba-Cosials J, Rodríguez-Palomares JF, Aguadé-Bruix S. Update on cardiac imaging techniques 2014. ACTA ACUST UNITED AC 2014; 68:129-35. [PMID: 25547375 DOI: 10.1016/j.rec.2014.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Accepted: 09/29/2014] [Indexed: 01/08/2023]
Abstract
In this article, we review the contributions of the most important imaging techniques used in cardiology, reported in 2014. Echocardiography remains the cornerstone for diagnosing and monitoring valvular heart disease, and there has been a continuing effort to improve quantification of this condition and obtain prognostic parameters for follow-up. The study of regional myocardial function is anchored in the diagnosis of subclinical ventricular dysfunction, and 3-dimensional transesophageal echocardiography has become the perfect ally in interventional procedures for structural heart disease. Cardiac magnetic resonance imaging and cardiac computed tomography are the focus of most publications on cardiac imaging in ischemic heart disease, reflecting their consolidated use in clinical practice. Nuclear medicine excels in the study of myocardial viability after interventional treatment of acute coronary syndromes and its performance is validated in the diagnosis of ischemic heart disease.
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Affiliation(s)
| | - Rocío García-Orta
- Servicio de Cardiología, Hospital Virgen de las Nieves, Granada, Spain
| | | | - Joaquín Barba-Cosials
- Departamento de Cardiología, Clínica Universidad de Navarra, Pamplona, Navarre, Spain
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