1
|
Becher H, Alhumaid W, Windram J, Choy J. Contrast Echocardiography in Heart Failure: Update 2023. Curr Heart Fail Rep 2024; 21:63-72. [PMID: 38305851 DOI: 10.1007/s11897-024-00647-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/09/2024] [Indexed: 02/03/2024]
Abstract
PURPOSE OF REVIEW The application of ultrasound-enhancing agents (contrast agents) has improved the accuracy and reproducibility of echocardiography. The review focuses on the currently approved and evolving indications for contrast echocardiography in patients with heart failure, specifically examining clinical studies conducted after the publication of the guidelines in 2017 and 2018. RECENT FINDINGS The current ASE/EACVI recommendations for contrast echocardiography are based on its accuracy and reproducibility in comparison to non-enhanced echocardiography or other imaging modalities like cardiac MRI. However, tissue characterization remains limited with contrast echocardiography. During the last few years, several studies have demonstrated the clinical impact of using contrast agents on the management of patients with heart failure. There is growing evidence on the benefit of using contrast echocardiography in critically ill patients where echocardiography without contrast agents is often suboptimal and other imaging methods are less feasible. There is no risk of worsening renal function after the administration of ultrasound-enhancing agents, and these agents can be administered even in patients with end-stage renal disease. Contrast echocardiography has become a valuable tool for first-line imaging of patients with heart failure across the spectrum of patients with chronic heart failure to critically ill patients.
Collapse
Affiliation(s)
- Harald Becher
- ABACUS, Mazankowski Alberta Heart Institute, University of Alberta Hospital, 0A8.32, 8440 112 Street Edmonton, Alberta, T6G 2B7, Canada.
| | - Waleed Alhumaid
- ABACUS, Mazankowski Alberta Heart Institute, University of Alberta Hospital, 0A8.32, 8440 112 Street Edmonton, Alberta, T6G 2B7, Canada
| | - Jonathan Windram
- ABACUS, Mazankowski Alberta Heart Institute, University of Alberta Hospital, 0A8.32, 8440 112 Street Edmonton, Alberta, T6G 2B7, Canada
| | - Jonathan Choy
- ABACUS, Mazankowski Alberta Heart Institute, University of Alberta Hospital, 0A8.32, 8440 112 Street Edmonton, Alberta, T6G 2B7, Canada
| |
Collapse
|
2
|
Horváth M, Farkas-Sütő K, Fábián A, Lakatos B, Kiss AR, Grebur K, Gregor Z, Mester B, Kovács A, Merkely B, Szűcs A. Highlights of right ventricular characteristics of left ventricular noncompaction using 3D echocardiography. IJC HEART & VASCULATURE 2023; 49:101289. [PMID: 38035261 PMCID: PMC10684825 DOI: 10.1016/j.ijcha.2023.101289] [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: 08/15/2023] [Revised: 10/19/2023] [Accepted: 10/22/2023] [Indexed: 12/02/2023]
Abstract
Highlights of right ventricular characteristics of left ventricular noncompaction using 3D echocardiography. The aspects of right ventricular volumes and function investigated with 3D echocardiography in a large cohort of left ventricular noncompaction morphology (LVNC) population remains unclear. The objective of our research was to study the left (LV) and right (RV) ventricular parameters using 3D echocardiography and analyze the clinical features of a LVNC population with preserved LV ejection fraction (EF > 50 %) in comparison with healthy controls (HC). We selected 41 LVNC subjects with preserved LV function (EF: 52.91 ± 3 %, male n = 26) and without any comorbidities and compared them with an age and sex-matched HC. Three dimensional endocardial contours were evaluated to determine the following LV and RV parameters: end-diastolic (EDV) and end-systolic (ESV) volumes, stroke volume, EF, LV global longitudinal and circumferential strain and RV septal and free wall longitudinal strain. Regarding the clinical characteristics, the family involvement had a notable proportion, accounting for 51%. The EF and strain values of the LVNC population were significantly decreased in both RV and LV compared to HC. Although the LV volumes of the LVNC group were significantly elevated, the RV volumetric parameters did not differ significantly compared to controls. We found significant correlations between LV and RV volumetric and functional parameters and linear regression models showed that LV EDV and LV ESV determined the RV volumetric values. While the alteration and relationship of the RV parameters may represent the potential of biventricular involvement, clinical characteristics of the LVNC group underlines the necessity of monitoring this population, even with preserved EF.
Collapse
Affiliation(s)
- Márton Horváth
- Heart and Vascular Center of Semmelweis University, Városmajor str. 68, 1122 Budapest, Hungary
| | - Kristóf Farkas-Sütő
- Heart and Vascular Center of Semmelweis University, Városmajor str. 68, 1122 Budapest, Hungary
| | - Alexandra Fábián
- Heart and Vascular Center of Semmelweis University, Városmajor str. 68, 1122 Budapest, Hungary
| | - Bálint Lakatos
- Heart and Vascular Center of Semmelweis University, Városmajor str. 68, 1122 Budapest, Hungary
| | - Anna Réka Kiss
- Heart and Vascular Center of Semmelweis University, Városmajor str. 68, 1122 Budapest, Hungary
| | - Kinga Grebur
- Heart and Vascular Center of Semmelweis University, Városmajor str. 68, 1122 Budapest, Hungary
| | - Zsófia Gregor
- Heart and Vascular Center of Semmelweis University, Városmajor str. 68, 1122 Budapest, Hungary
| | - Balázs Mester
- Heart and Vascular Center of Semmelweis University, Városmajor str. 68, 1122 Budapest, Hungary
| | - Attila Kovács
- Heart and Vascular Center of Semmelweis University, Városmajor str. 68, 1122 Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center of Semmelweis University, Városmajor str. 68, 1122 Budapest, Hungary
| | - Andrea Szűcs
- Heart and Vascular Center of Semmelweis University, Városmajor str. 68, 1122 Budapest, Hungary
| |
Collapse
|
3
|
Cotter B, Raisinghani A, DeMaria AN. Established and emerging roles for ultrasound enhancing agents (contrast echocardiography). Clin Cardiol 2022; 45:1114-1122. [PMID: 36183366 DOI: 10.1002/clc.23924] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 08/22/2022] [Indexed: 11/10/2022] Open
Abstract
The ability to opacify the left ventricle and delineate the endocardium after intravenous injection of microbubble ultrasound enhancing agents is of established value to quantify volumes and function in suboptimal unenhanced images, particularly in stress echocardiograms. However, applications other than quantitation of left ventricle structure and function exist for contrast enhanced left ventricular opacification. Contrast agents enable recording of Doppler velocity signals in patients with poor ultrasound transmission, providing estimates of aortic stenosis gradient and pulmonary artery pressures. Contrast echo is of value in detecting apical hypertrophic cardiomyopathy and accompanying apical aneurysms. Most importantly, ultrasound enhancing agents can identify apical and left atrial masses when they cannot be visualized in unenhanced images, and can distinguish thrombi from tumors by visualizing the vascularity inherent in tumors. Contrast agents distinguish trabecular from compacted myocardium in noncompaction syndrome, and hypertrabeculation with other abnormal conditions. A major potential application of ultrasound enhancing agents is myocardial opacification, which can assist in identifying nonviable myocardium. Also, the delayed reappearance of myocardial perfusion after microbubble destruction identifies impaired contrary flow and can diagnose coronary stenosis. Innovative applications of ultrasound contrast agents currently under investigation, include visualizing the vaso vasorum to identify plaques and assess their vulnerability, and theranostic agents to deliver drugs and biologists and to assist in sonothrombolysis. It is anticipated that the role of ultrasound contrast agents will continue to increase in the future.
Collapse
Affiliation(s)
- Bruno Cotter
- Division of Cardiology, Department of Medicine, Sulpizio Cardiovascular Center, University of California San Diego, San Diego, California, USA
| | - Ajit Raisinghani
- Division of Cardiology, Department of Medicine, Sulpizio Cardiovascular Center, University of California San Diego, San Diego, California, USA
| | - Anthony N DeMaria
- Division of Cardiology, Department of Medicine, Sulpizio Cardiovascular Center, University of California San Diego, San Diego, California, USA
| |
Collapse
|
4
|
Left Ventricular Non-Compaction Cardiomyopathy-Still More Questions than Answers. J Clin Med 2022; 11:jcm11144135. [PMID: 35887898 PMCID: PMC9315982 DOI: 10.3390/jcm11144135] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 12/24/2022] Open
Abstract
Left ventricular non-compaction (LVNC) describes the phenotypical phenomena characterized by the presence of excessive trabeculation of the left ventricle which forms a deep recess filled with blood. Considering the lack of a uniform definition of LVNC as well as the "golden standard" it is difficult to estimate the actual incidence of the disease, however, seems to be overdiagnosed, due to unspecific diagnostic criteria. The non-compacted myocardium may appear both as a disease representation or variant of the norm or as an adaptive phenomenon. This article covers different approaches to incidence, pathogenesis, diagnostics, and treatment of LVNC as well as recommendations for patients during follow-up.
Collapse
|