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Zhao R, Sun W, Li Y, Wu A, Chen X, Lou J, Zhang S, Tan Y, Zhang L, Xie M, Lv Q. Application of apical myocardial perfusion quantitative analysis by contrast-enhanced ultrasound utilizing high-frequency linear probe. Echocardiography 2024; 41:e15886. [PMID: 39007877 DOI: 10.1111/echo.15886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 06/22/2024] [Accepted: 06/25/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND Due to insufficient near-field resolution and artifacts, it is challenging to evaluate the left ventricular apical perfusion with phased-array probes. By combining high-frequency linear probe and contrast-enhanced ultrasound (CEUS), imaging of apical myocardial perfusion could be improved. The study aims to evaluate the preliminary application of CEUS by high-frequency linear probes to assess the apical perfusion. METHODS The study enrolled retrospectively 91 patients to test the feasibility of the novel method. In protocol 1, patients were stratified into a group with left anterior descending artery (LAD) stenosis (N = 40) and a group without LAD stenosis or coronary artery disease (N = 41) based on the degree of coronary artery narrowing, quantified by >50% stenosis in coronary angiography. Receiver operating characteristics (ROC) analysis was performed to test the diagnostic value of perfusion parameters. In protocol 2, the reproducibility of high-frequency linear probe in apical perfusion analysis was compared with the conventional phased-array probe in 30 patients. RESULTS (1) The novel method is feasible in 81(89.01%) patients. (2) In protocol 1, to detect LAD stenosis, the best cut-off of β, T, A, and MBF were 10.32, 3.28, 9.39, and 4.99, respectively. Area under the curve of β, T, A, and MBF were .880, .881, .761, and .880, respectively. (3) In protocol 2, compared with phased-array probe, the quantitative analysis of high-frequency linear probe is of high reproducibility and could get good curve fitting (R2 = .29 vs. R2 = .71, P < .01). CONCLUSION Observation of apical perfusion using this method is feasible and quantitative analysis allows an accurate and convenient identification of LAD stenosis. This method provides an alternative for patients who have difficulties in visualizing the apical region with a phased-array probe.
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Affiliation(s)
- Ruohan Zhao
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Wei Sun
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yuman Li
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Anjun Wu
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Xin Chen
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Jie Lou
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Siyi Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yuting Tan
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Li Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Mingxing Xie
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Qing Lv
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
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2
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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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3
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Dobutamine-induced Takotsubo syndrome in a paediatric heart transplant patient. Cardiol Young 2022; 33:646-648. [PMID: 35899969 DOI: 10.1017/s1047951122002311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Takotsubo syndrome is a potentially reversible cause of acute systolic dysfunction. Takotsubo syndrome is rare in children, with no reported dobutamine-induced cases to date. We present a 14-year-old male with prior history of heart transplantation, who developed Takotsubo syndrome during dobutamine stress echocardiography. We highlight the importance of its early recognition to ensure supportive measures with avoidance of inotropic medications.
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4
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Multimodality Imaging to Detect Rejection, and Cardiac Allograft Vasculopathy in Pediatric Heart Transplant Recipients—An Illustrative Review. TRANSPLANTOLOGY 2022. [DOI: 10.3390/transplantology3030025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The three most common modalities of graft surveillance in pediatric heart transplant (HT) recipients include echocardiography, coronary angiography, and endomyocardial biopsy (EMB). The survival outcomes after HT in children have improved considerably in recent years. However, allograft rejection and cardiac allograft vasculopathy remain the leading cause of death or re-transplantation. The routine surveillance by EMB and coronary angiography are invasive and risky. Newer noninvasive echocardiographic techniques, including tissue Doppler imaging (TDI), 2-D speckle tracking echocardiography, CT coronary angiography (CTCA), cardiovascular magnetic resonance (CMR), single-photon emission computed tomography (SPECT), and positron emission tomography (PET) and invasive techniques such as intravascular ultrasound (IVUS), functional flow reserve (CFR) of coronary arteries, optical coherence tomography (OCT), have emerged as powerful tools which may help early recognition of sub-clinical rejection, response to treatment, early detection, and progression of CAV. The multimodality imaging approach, including noninvasive and invasive tests, is the future for the transplanted heart to detect dysfunction, rejections, and early CAV. This review illustrates noninvasive and invasive imaging techniques currently used or could be considered for clinical use in detecting heart transplant rejection, dysfunction, and CAV in children.
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5
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Perez MT, Rizwan R, Gauvreau K, Daly K, Deng E, Blume E, Singh TP, Chen MH. Prognostic Value of Exercise Stress Echocardiography in Pediatric Cardiac Transplant Recipients. J Am Soc Echocardiogr 2022; 35:1133-1138.e2. [PMID: 35863548 DOI: 10.1016/j.echo.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/03/2022] [Accepted: 07/07/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Cardiac allograft vasculopathy (CAV) is a leading cause of long-term morbidity and mortality in pediatric heart transplant (HTx) recipients. Exercise stress echocardiography (ESE) has been shown to be useful in the detection of angiographically-confirmed CAD in children. However, the prognostic utility of ESE for prediction of cardiac events in HTx survivors is unknown. STUDY AIM AND HYPOTHESIS Therefore, we aim to assess if an abnormal (positive) ESE will be associated with a higher risk of future cardiovascular (CV) outcomes in pediatric HTx recipients. MATERIAL AND METHODS We conducted a retrospective review of CV outcomes of a cohort of 95 pediatric HTx recipients who underwent 188 ESE over a 10-year period. A composite endpoint for CV events including myocardial infarction, hospitalization for non-rejection heart failure, coronary revascularization, need for repeat transplantation, and death was used. Based on the interpretation of the ESE results, each ESE study was classified for this study as either positive (abnormal), or negative (normal) for ischemia. Results of the coronary angiograms performed near the time of ESE were also assessed and classified for this study as positive (abnormal) or negative (normal) for CAV according to standard HTx criteria for CAV. RESULTS 51 (27%) ESE were positive for ischemia. There was a total of 35 CV events in 23 patients. A positive ESE was associated with increased risk of any CV event [Hazard ratio [HR] 3.55, 95% CI 1.52, 8.28, and also an increased risk of CV death (HR 3.19, 95% CI 1.23, 8.28) Freedom from composite CV outcome at 1, 2, and 3 years following a positive ESE was 89.9% (CI = 77.3%, 95.7%), 81.5% (CI = 65.9%, 90.5%), and 63.2% (CI = 41.9%, 78.5%), respectively. Freedom from composite cardiovascular outcome at 1, 2, and 3 years following a negative ESE was 99.3% (94.8, 99.9), 98.4% (93.6, 99.6), and 97.0% (90.6, 99.1) respectively. No patient died within 1 year of a negative ESE. CONCLUSIONS In this largest study of ESE in pediatric HTx recipients, a positive or abnormal ESE is associated with increased future cardiovascular morbidity and mortality. Conversely, a negative ESE can help predict CV event-free survival. Even in the setting of a normal ANG, our pilot data show that an abnormal ESE may be still clinically important. Use of ESE in follow-up may improve risk stratification and management of pediatric HTx recipients.
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Affiliation(s)
- Maria T Perez
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115
| | - Raheel Rizwan
- Department of Pediatrics, Division of Genetics and Genomics, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115
| | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115
| | - Kevin Daly
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115
| | - Ellen Deng
- Department of Pediatrics, Division of Genetics and Genomics, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115
| | - Elizabeth Blume
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115
| | - Tajinder P Singh
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115
| | - Ming Hui Chen
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115; Department of Pediatrics, Division of Genetics and Genomics, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115.
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6
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Tavares BG, Aguiar MO, Tsutsui J, Oliveira M, Soeiro ADM, Nicolau J, Ribeiro H, PoChiang H, Sbano J, Rochitte CE, Lopes B, Ramirez J, Kalil R, Mathias W. A Sonotrombólise Promove Melhora dos Índices de Motilidade e Perfusão do Ventrículo Esquerdo após o Infarto Agudo do Miocárdio. Arq Bras Cardiol 2022; 118:756-765. [PMID: 35508053 PMCID: PMC9007009 DOI: 10.36660/abc.20200651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 03/24/2021] [Indexed: 12/31/2022] Open
Abstract
Fundamento Demonstrou-se recentemente que a aplicação de ultrassom de alta energia com microbolhas, técnica conhecida como sonotrombólise, causa a dissolução de trombos intravasculares e aumenta a taxa de recanalização angiográfica no infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAM-CSST). Objetivo Avaliar o efeito da sonotrombólise nos índices de motilidade e perfusão miocárdicas em pacientes com IAM-CSST, utilizando a ecocardiografia com perfusão miocárdica em tempo real (EPMTR). Método Uma centena de pacientes com IAM-CSST foram randomizados em dois grupos: Terapia (50 pacientes tratados com sonotrombólise e angioplastia coronária primária) e Controle (50 pacientes tratados com angioplastia coronária primária). Os pacientes realizaram EPMTR para analisar a fração de ejeção do ventrículo esquerdo (FEVE), o índice de escore de motilidade segmentar (IEMS) e o número de segmentos com defeito de perfusão miocárdica, 72 horas após o IAM-CSST e com 6 meses de acompanhamento. Foi considerado significativo p < 0,05. Resultados Pacientes tratados com sonotrombólise apresentaram FEVE mais alta que o grupo Controle em 72 horas (50 ± 10%
vs.
44 ± 10%; p = 0,006), e essa melhora foi mantida em seis meses (53 ± 10%
vs.
48 ± 12%; p = 0,008). O IEMS foi similar nos grupos Terapia e Controle em 72 horas (1,62 ± 0,39
vs.
1,75 ± 0,40; p = 0,09), mas tornou-se menor no grupo Terapia em 6 meses (1,46 ± 0,36
vs.
1,64 ± 0,44; p = 0,02). O número de segmentos com defeito de perfusão não foi diferente entre os grupos em 72 horas (5,92 ± 3,47
vs.
6,94 ± 3,39; p = 0,15), mas ficou menor no grupo Terapia em 6 meses (4,64 ± 3,31
vs.
6,57 ± 4,29; p = 0,01). Conclusão A sonotrombólise em pacientes com IAM-CSST resulta na melhora dos índices de motilidade e perfusão ventricular ao longo do tempo.
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Raftopoulos L, Aggeli C, Dimitroglou Y, Kakiouzi V, Tsartsalis D, Patsourakos D, Tsioufis C. The fundamental role of stress echo in evaluating coronary artery disease in specific patient populations. Curr Vasc Pharmacol 2021; 20:156-167. [PMID: 34931964 DOI: 10.2174/1570161120666211220104156] [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: 07/13/2021] [Revised: 11/06/2021] [Accepted: 11/19/2021] [Indexed: 11/22/2022]
Abstract
Stress echocardiography (SE) was initially used for assessing patients with known or suspected coronary heart disease by detecting and evaluating myocardial ischemia and viability. The implementation of SE has gradually been extended to several cardiovascular diseases beyond coronary artery disease, and SE protocols have been modified and adapted for the detection of coronary artery disease (CAD) or other cardiovascular diseases in specific patient populations. This review attempts to summarize current data concerning SE implementation and clinical value in these specific and diverse populations: patients with an intramural course of a coronary artery - known as a myocardial bridge, chronic severe or end-stage hepatic disease, chronic severe or end-stage kidney disease, cardiac allograft vasculopathy, patients scheduled for solid-organ transplantation and other intermediate and high-risk surgery and, finally, patients treated with anticancer drugs or radiotherapy.
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Affiliation(s)
- Leonidas Raftopoulos
- First Department of Cardiology, University of Athens Medical School, General Hospital of Athens Hippokration, Athens, Greece
| | - Constantina Aggeli
- First Department of Cardiology, University of Athens Medical School, General Hospital of Athens Hippokration, Athens, Greece
| | - Yannis Dimitroglou
- First Department of Cardiology, University of Athens Medical School, General Hospital of Athens Hippokration, Athens, Greece
| | - Vasiliki Kakiouzi
- First Department of Cardiology, University of Athens Medical School, General Hospital of Athens Hippokration, Athens, Greece
| | - Dimitrios Tsartsalis
- First Department of Cardiology, University of Athens Medical School, General Hospital of Athens Hippokration, Athens, Greece
| | - Dimitrios Patsourakos
- First Department of Cardiology, University of Athens Medical School, General Hospital of Athens Hippokration, Athens, Greece
| | - Costas Tsioufis
- First Department of Cardiology, University of Athens Medical School, General Hospital of Athens Hippokration, Athens, Greece
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