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Oon CE, Subramaniam AV, Ooi LY, Yehya AHS, Lee YT, Kaur G, Sasidharan S, Qiu B, Wang X. BZD9L1 benzimidazole analogue hampers colorectal tumor progression by impeding angiogenesis. World J Gastrointest Oncol 2023; 15:810-827. [PMID: 37275453 PMCID: PMC10237024 DOI: 10.4251/wjgo.v15.i5.810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/17/2023] [Accepted: 04/21/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND The development of new vasculatures (angiogenesis) is indispensable in supplying oxygen and nutrients to fuel tumor growth. Epigenetic dysregulation in the tumor vasculature is critical to colorectal cancer (CRC) progression. Sirtuin (SIRT) enzymes are highly expressed in blood vessels. BZD9L1 benzimidazole analogue is a SIRT 1 and 2 inhibitor with reported anticancer activities in CRC. However, its role has yet to be explored in CRC tumor angiogenesis.
AIM To investigate the anti-angiogenic potential of BZD9L1 on endothelial cells (EC) in vitro, ex vivo and in HCT116 CRC xenograft in vivo models.
METHODS EA.hy926 EC were treated with half inhibitory concentration (IC50) (2.5 μM), IC50 (5.0 μM), and double IC50 (10.0 μM) of BZD9L1 and assessed for cell proliferation, adhesion and SIRT 1 and 2 protein expression. Next, 2.5 μM and 5.0 μM of BZD9L1 were employed in downstream in vitro assays, including cell cycle, cell death and sprouting in EC. The effect of BZD9L1 on cell adhesion molecules and SIRT 1 and 2 were assessed via real-time quantitative polymerase chain reaction (qPCR). The growth factors secreted by EC post-treatment were evaluated using the Quantibody Human Angiogenesis Array. Indirect co-culture with HCT116 CRC cells was performed to investigate the impact of growth factors modulated by BZD9L1-treated EC on CRC. The effect of BZD9L1 on sprouting impediment and vessel regression was determined using mouse choroids. HCT116 cells were also injected subcutaneously into nude mice and analyzed for the outcome of BZD9L1 on tumor necrosis, Ki67 protein expression indicative of proliferation, cluster of differentiation 31 (CD31) and CD34 EC markers, and SIRT 1 and 2 genes via hematoxylin and eosin, immunohistochemistry and qPCR, respectively.
RESULTS BZD9L1 impeded EC proliferation, adhesion, and spheroid sprouting through the downregulation of intercellular adhesion molecule 1, vascular endothelial cadherin, integrin-alpha V, SIRT1 and SIRT2 genes. The compound also arrested the cells at G1 phase and induced apoptosis in the EC. In mouse choroids, BZD9L1 inhibited sprouting and regressed sprouting vessels compared to the negative control. Compared to the negative control, the compound also reduced the protein levels of angiogenin, basic fibroblast growth factor, platelet-derived growth factor and placental growth factor, which then inhibited HCT116 CRC spheroid invasion in co-culture. In addition, a significant reduction in CRC tumor growth was noted alongside the downregulation of human SIRT1 (hSIRT1), hSIRT2, CD31, and CD34 EC markers and murine SIRT2 gene, while the murine SIRT1 gene remained unaffected, compared to vehicle control. Histology analyses revealed that BZD9L1 at low (50 mg/kg) and high (250 mg/kg) doses reduced Ki-67 protein expression, while BZD9L1 at the high dose diminished tumor necrosis compared to vehicle control.
CONCLUSION These results highlighted the anti-angiogenic potential of BZD9L1 to reduce CRC tumor progression. Furthermore, together with previous anticancer findings, this study provides valuable insights into the potential of BZD9L1 to co-target CRC tumor vasculatures and cancer cells via SIRT1 and/or SIRT2 down-regulation to improve the therapeutic outcome.
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Affiliation(s)
- Chern Ein Oon
- Institute for Research in Molecular Medicine, Universiti Sains Malaysia, Penang 11800, Malaysia
| | - Ayappa V Subramaniam
- Institute for Research in Molecular Medicine, Universiti Sains Malaysia, Penang 11800, Malaysia
| | - Lik Yang Ooi
- Institute for Research in Molecular Medicine, Universiti Sains Malaysia, Penang 11800, Malaysia
| | - Ashwaq Hamid Salem Yehya
- Cancer Research, Eman Biodiscoveries, Kedah 08000, Malaysia
- Vatche and Tamar Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA 90095, United States
| | - Yeuan Ting Lee
- Institute for Research in Molecular Medicine, Universiti Sains Malaysia, Penang 11800, Malaysia
| | - Gurjeet Kaur
- Institute for Research in Molecular Medicine, Universiti Sains Malaysia, Penang 11800, Malaysia
| | - Sreenivasan Sasidharan
- Institute for Research in Molecular Medicine, Universiti Sains Malaysia, Penang 11800, Malaysia
| | - Beiying Qiu
- Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore 169857, Singapore
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore 168751, Singapore
| | - Xiaomeng Wang
- Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore 169857, Singapore
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore 169857, Singapore
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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.
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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
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Yamagishi M, Tamaki N, Akasaka T, Ikeda T, Ueshima K, Uemura S, Otsuji Y, Kihara Y, Kimura K, Kimura T, Kusama Y, Kumita S, Sakuma H, Jinzaki M, Daida H, Takeishi Y, Tada H, Chikamori T, Tsujita K, Teraoka K, Nakajima K, Nakata T, Nakatani S, Nogami A, Node K, Nohara A, Hirayama A, Funabashi N, Miura M, Mochizuki T, Yokoi H, Yoshioka K, Watanabe M, Asanuma T, Ishikawa Y, Ohara T, Kaikita K, Kasai T, Kato E, Kamiyama H, Kawashiri M, Kiso K, Kitagawa K, Kido T, Kinoshita T, Kiriyama T, Kume T, Kurata A, Kurisu S, Kosuge M, Kodani E, Sato A, Shiono Y, Shiomi H, Taki J, Takeuchi M, Tanaka A, Tanaka N, Tanaka R, Nakahashi T, Nakahara T, Nomura A, Hashimoto A, Hayashi K, Higashi M, Hiro T, Fukamachi D, Matsuo H, Matsumoto N, Miyauchi K, Miyagawa M, Yamada Y, Yoshinaga K, Wada H, Watanabe T, Ozaki Y, Kohsaka S, Shimizu W, Yasuda S, Yoshino H. JCS 2018 Guideline on Diagnosis of Chronic Coronary Heart Diseases. Circ J 2021; 85:402-572. [PMID: 33597320 DOI: 10.1253/circj.cj-19-1131] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
| | - Nagara Tamaki
- Department of Radiology, Kyoto Prefectural University of Medicine Graduate School
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Graduate School
| | - Kenji Ueshima
- Center for Accessing Early Promising Treatment, Kyoto University Hospital
| | - Shiro Uemura
- Department of Cardiology, Kawasaki Medical School
| | - Yutaka Otsuji
- Second Department of Internal Medicine, University of Occupational and Environmental Health, Japan
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School
| | | | | | - Hajime Sakuma
- Department of Radiology, Mie University Graduate School
| | | | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School
| | | | - Hiroshi Tada
- Department of Cardiovascular Medicine, University of Fukui
| | | | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | | | - Kenichi Nakajima
- Department of Functional Imaging and Artificial Intelligence, Kanazawa Universtiy
| | | | - Satoshi Nakatani
- Division of Functional Diagnostics, Department of Health Sciences, Osaka University Graduate School of Medicine
| | | | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
| | - Atsushi Nohara
- Division of Clinical Genetics, Ishikawa Prefectural Central Hospital
| | | | | | - Masaru Miura
- Department of Cardiology, Tokyo Metropolitan Children's Medical Center
| | | | | | | | - Masafumi Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University
| | - Toshihiko Asanuma
- Division of Functional Diagnostics, Department of Health Sciences, Osaka University Graduate School
| | - Yuichi Ishikawa
- Department of Pediatric Cardiology, Fukuoka Children's Hospital
| | - Takahiro Ohara
- Division of Community Medicine, Tohoku Medical and Pharmaceutical University
| | - Koichi Kaikita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | - Tokuo Kasai
- Department of Cardiology, Uonuma Kinen Hospital
| | - Eri Kato
- Department of Cardiovascular Medicine, Department of Clinical Laboratory, Kyoto University Hospital
| | | | - Masaaki Kawashiri
- Department of Cardiovascular and Internal Medicine, Kanazawa University
| | - Keisuke Kiso
- Department of Diagnostic Radiology, Tohoku University Hospital
| | - Kakuya Kitagawa
- Department of Advanced Diagnostic Imaging, Mie University Graduate School
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School
| | | | | | | | - Akira Kurata
- Department of Radiology, Ehime University Graduate School
| | - Satoshi Kurisu
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center
| | - Eitaro Kodani
- Department of Internal Medicine and Cardiology, Nippon Medical School Tama Nagayama Hospital
| | - Akira Sato
- Department of Cardiology, University of Tsukuba
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Graduate School
| | - Junichi Taki
- Department of Nuclear Medicine, Kanazawa University
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, Hospital of the University of Occupational and Environmental Health, Japan
| | | | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center
| | - Ryoichi Tanaka
- Department of Reconstructive Oral and Maxillofacial Surgery, Iwate Medical University
| | | | | | - Akihiro Nomura
- Innovative Clinical Research Center, Kanazawa University Hospital
| | - Akiyoshi Hashimoto
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University
| | - Kenshi Hayashi
- Department of Cardiovascular Medicine, Kanazawa University Hospital
| | - Masahiro Higashi
- Department of Radiology, National Hospital Organization Osaka National Hospital
| | - Takafumi Hiro
- Division of Cardiology, Department of Medicine, Nihon University
| | | | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center
| | - Naoya Matsumoto
- Division of Cardiology, Department of Medicine, Nihon University
| | | | | | | | - Keiichiro Yoshinaga
- Department of Diagnostic and Therapeutic Nuclear Medicine, Molecular Imaging at the National Institute of Radiological Sciences
| | - Hideki Wada
- Department of Cardiology, Juntendo University Shizuoka Hospital
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University
| | - Yukio Ozaki
- Department of Cardiology, Fujita Medical University
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
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4
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Pellikka PA, Arruda-Olson A, Chaudhry FA, Chen MH, Marshall JE, Porter TR, Sawada SG. Guidelines for Performance, Interpretation, and Application of Stress Echocardiography in Ischemic Heart Disease: From the American Society of Echocardiography. J Am Soc Echocardiogr 2020; 33:1-41.e8. [DOI: 10.1016/j.echo.2019.07.001] [Citation(s) in RCA: 124] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Gaibazzi N, Tuttolomondo D, Rabia G, Lorenzoni V, Benatti G, De Rosa F. Standard echocardiography versus very-low mechanical index contrast-imaging: left ventricle volumes and ejection fraction multi-reader variability and reference values in a subgroup with no risk factors or cardiac disease. Heart Vessels 2019; 35:544-554. [PMID: 31531717 DOI: 10.1007/s00380-019-01506-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 09/06/2019] [Indexed: 01/08/2023]
Abstract
We retrospectively assessed the rest-phase images of 300 contrast stress- echocardiograms, during which very-low mechanical index (VLMI) imaging with ultrasound enhancing agents (UEAs) was routinely acquired in addition to greyscale echocardiography; intra- and inter-reader variability for left ventricle (LV) volumes and ejection fraction (LVEF) at rest was established in the overall cohort and normal values were calculated in the subset of subjects with no cardiac risk factors or cardiac disease and a normal stress-echocardiogram. Current recommendations for chamber quantification using echocardiography advise the use of UEAs in case of insufficient quality of endocardial visualization, but normal values for LV volumes and LVEF using UEAs have never been published using currently recommended VLMI method. Single-centre retrospective study, enrolling subjects referred to contrast stress- echocardiography for suspect coronary artery disease, including the acquisition of both standard 2D greyscale and bolus UEAs with VLMI, regardless of the image quality. This enables offline measurement of the LV volumes and LVEF for both greyscale and UEAs-VLMI images at rest in all subjects. Images were allocated to 3 readers in random order. Normal range for LV volumes and LVEF was also derived in a subset of apparently healthy subjects. In the 298 exams finally assessed, measurement variability among the three readers was lower with UEAs-VLMI, in particular for end-systolic volumes (intra-class correlation coefficient for concordance improved from 0.855 to 0.916, for LVEF from 0.68 to 0.783, p < 0.01), intra- observer variability reduced (Lin's correlation coefficient for LVEF from 0.747 to 0.857, p < 0.01). Normal mean indexed LV end-diastolic volume with UEAs-VLMI, compared to greyscale imaging, was + 14 ml/m2, while LVEF was + 5 to + 6% points. This is the largest study specifically addressing UEAs-VLMI imaging and comparing data with standard greyscale imaging; it demonstrates a reduction in measurement variability of LV volumes and LVEF. Normal reference values for VLMI ultrasound are reported for the first time in comparison with greyscale values.
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Affiliation(s)
- Nicola Gaibazzi
- Parma University Hospital, Via Gramsci 14, 43123, Parma, Italy.
| | | | - Granit Rabia
- Parma University Hospital, Via Gramsci 14, 43123, Parma, Italy
| | - Valentina Lorenzoni
- Management Institute, Sant'Anna Scuola Universitaria Superiore Pisa, Piazza Martiri Della Libertà, 33, 56127, Pisa, PI, Italy
| | - Giorgio Benatti
- Parma University Hospital, Via Gramsci 14, 43123, Parma, Italy
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Li Y, Chahal N, Senior R, Tang MX. Reproducible Computer-Assisted Quantification of Myocardial Perfusion with Contrast-Enhanced Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:2235-2246. [PMID: 28693906 DOI: 10.1016/j.ultrasmedbio.2017.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 04/02/2017] [Accepted: 05/01/2017] [Indexed: 06/07/2023]
Abstract
Myocardial perfusion can be quantified by myocardial contrast echocardiography (MCE) and is used for the diagnosis of coronary artery disease (CAD). However, existing MCE quantification software is highly operator dependent and has poor reproducibility and ease of usage. The aim of this study was to develop robust and easy-to-use software that can perform MCE quantification accurately, reproducibly and rapidly. The developed software has the following features: (i) semi-automatic segmentation of the myocardium; (ii) automatic rejection of MCE data with poor image quality; (iii) automatic computation of perfusion parameters such as myocardial blood flow (MBF). MCE sequences of 18 individuals (9 normal, 9 with CAD) undergoing vasodilator stress with dipyridamole were analysed quantitatively using the software. When evaluated against coronary angiography, the software achieved a sensitivity of 71% and a specificity of 91% for hyperemic MBF. With the automatic rejection algorithm, the sensitivity and specificity further improved to 77% and 94%, respectively. For MBF reproducibility, the percentage agreement is 85% (κ = 0.65) for inter-observer variability and 88% (κ = 0.72) for intra-observer variability. The intra-class correlation coefficients are 0.94 (inter-observer) and 0.96 (intra-observer). The time taken to analyse one MCE sequence using the software is about 3 min on a PC. The software has exhibited good diagnostic performance and reproducibility for CAD detection and is rapid and user-friendly.
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Affiliation(s)
- Yuanwei Li
- Department of Bioengineering, Imperial College London, London, UK
| | - Navtej Chahal
- Department of Echocardiography, Royal Brompton Hospital, London, UK; Biomedical Research Unit, National Heart and Lung Institute, Imperial College, London, UK
| | - Roxy Senior
- Department of Echocardiography, Royal Brompton Hospital, London, UK; Biomedical Research Unit, National Heart and Lung Institute, Imperial College, London, UK
| | - Meng-Xing Tang
- Department of Bioengineering, Imperial College London, London, UK.
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Abdel-Salam Z, Ghazy M, Khaled M, Nammas W. Acute Beta Blockade at Peak Stress: Will It Alter the Sensitivity of Dobutamine Stress Echocardiography in Patients with Normal Resting Wall Motion? ACTA CARDIOLOGICA SINICA 2016; 32:89-95. [PMID: 27122936 DOI: 10.6515/acs20150204d] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND We compared the accuracy of recovery phase images following administration of intravenous propranolol with peak stress images, for detection of coronary artery disease in patients with no resting wall motion abnormalities undergoing dobutamine stress echocardiography. METHODS We enrolled 100 consecutive patients with no resting wall motion abnormalities who underwent dobutamine stress echocardiography. Propranolol was injected after termination of dobutamine infusion. Positive peak stress images were defined as the induction of wall motion abnormalities at any stage before propranolol injection. Positive recovery phase images were defined as maintenance or worsening of wall motion abnormalities induced at peak stress, or the appearance of new wall motion abnormalities during recovery phase. Significant coronary stenosis was defined as ≥ 50% obstruction of ≥ 1 sizable artery by coronary angiography. RESULTS Seventy-two patients (72%) had significant coronary artery disease. Analysis of peak stress images revealed sensitivity, specificity, positive and negative predictive values of 80.6%, 85.7%, 93.5%, and 63.2%; the overall accuracy was 82%. Analysis of the recovery phase images revealed sensitivity, specificity, positive and negative predictive values of 91.7%, 75%, 90.4%, and 77.8%; here, the overall accuracy was 87%. CONCLUSIONS In patients with no resting wall motion abnormalities, acute beta blockade during dobutamine stress echocardiography improved the sensitivity of recovery phase images for detection of significant coronary artery disease versus peak stress images, but with reduced specificity. KEY WORDS Accuracy; Beta blocker; Coronary artery disease; Dobutamine stress echocardiography; Recovery phase images.
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Affiliation(s)
- Zainab Abdel-Salam
- Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed Ghazy
- Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed Khaled
- Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Wail Nammas
- Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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9
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Nguyen J, Juneman E, Movahed MR. The Value of β-Blockers Administration during Recovery Phase of Dobutamine Stress Echocardiography: A Review. Echocardiography 2013; 30:723-9. [DOI: 10.1111/echo.12201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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10
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Li DY, Liang L, Xu TD, Zhang H, Pan DF, Chen JH, Chen J, Wang XP. The value of quantitative real-time myocardial contrast echocardiography for detection of angiographically significant coronary artery disease. Clin Cardiol 2013; 36:468-74. [PMID: 23754666 DOI: 10.1002/clc.22142] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 04/15/2013] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Real-time (RT) myocardial contrast echocardiography (MCE) is a novel method for the assessment of regional myocardial perfusion. We sought to evaluate the feasibility and diagnostic accuracy of quantitative RT-MCE in predicting significant coronary stenosis, with reference to quantitative coronary angiography. HYPOTHESIS RT-MCE can identify anatomically significant coronary artery stenosis in selected patients. RT-MCE is probably an effective method for detection of angiographically significant coronary artery stenosis. METHODS Thirty-five patients (mean age, 59.94 ± 10.63 years; 25 males) scheduled for coronary angiography underwent RT-MCE at rest, and shortly afterward underwent gated single-photon emission computed tomography (gated-SPECT). Coronary angiography was performed within 1 week after RT-MCE in all patients. The observing indexes included the images of RT-MCE that were analyzed quantitatively from microbubble replenishment curves for myocardial perfusion by using the Q-Lab software. The sensitivity and specificity of RT-MCE for quantitative detection of coronary artery disease (CAD) were obtained. The receiver operator characteristic (ROC) curves were used to assess the differences of accuracy in ischemic segments with A, β and A × β respectively. The sensitivity and specificity of gated-SPECT and RT-MCE for assessment of CAD were calculated using a 4-score method. RESULTS A total of 513 segments among 595 segments in 35 patients were obtained. The cutoffs for A, β and A × β were 4.58, 0.64, and 2.73, and the sensitivity and specificity of quantitative RT-MCE for detection of CAD were 86.0%, 80.2%, 88.9%, and 84.1%, 64.6%, 79.9%, respectively. Meanwhile, the sensitivity and specificity of semiquantitative analysis for assessment of CAD were 66.7% and 61.8%. The ROC curve area of A and A × β was 0.91 and 0.90 in the middle segments. The ROC area of A was 0.52 in the base segments. The sensitivity and specificity of gated-SPECT for assessment of CAD were 84.8% and 82.7%, respectively. The sensitivity of multi-indexes RT-MCE increased. The sensitivity was 89.1%, 90.4%, and 96.3% by A + β, A + A × β, and β + A × β. CONCLUSIONS Quantitative RT-MCE is an effective method for the detection of coronary artery stenosis. Quantitative RT-MCE is segmented for assessment to ischemic myocardium. RT-MCE with multi-indexes has a valuable application for assessment of CAD surpassing SPECT.
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Affiliation(s)
- Dong-ye Li
- Cardiovascular Disease Institute of Xuzhou Medical College, Xuzhou, China
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11
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The Role of Noninvasive Imaging in Coronary Artery Disease Detection, Prognosis, and Clinical Decision Making. Can J Cardiol 2013; 29:285-96. [PMID: 23357601 DOI: 10.1016/j.cjca.2012.10.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 10/18/2012] [Accepted: 10/23/2012] [Indexed: 12/14/2022] Open
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12
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Miszalski-Jamka T, Kuntz-Hehner S, Tiemann K, Karwat K, Kostkiewicz M. Quantitative Myocardial Contrast Supine Bicycle Stress Echocardiography for Detection of Coronary Artery Disease. Echocardiography 2012; 30:392-400. [DOI: 10.1111/echo.12064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Tomasz Miszalski-Jamka
- Center for Diagnosis, Prevention and Telemedicine; John Paul II Hospital; Kraków; Poland
| | | | - Klaus Tiemann
- Department of Cardiology and Angiology; Hospital of the University of Münster; Münster; Germany
| | - Krzysztof Karwat
- Center for Diagnosis, Prevention and Telemedicine; John Paul II Hospital; Kraków; Poland
| | - Magdalena Kostkiewicz
- Center for Diagnosis, Prevention and Telemedicine; John Paul II Hospital; Kraków; Poland
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13
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Abdelmoneim SS, Mulvagh SL. Perflutren lipid microsphere injectable suspension for cardiac ultrasound. ACTA ACUST UNITED AC 2012. [DOI: 10.2217/iim.12.11] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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14
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Hong GR, Park JS, Lee SH, Shin DG, Kim U, Choi JH, Abdelmalik R, Vera JA, Kim JK, Narula J, Vannan MA. Prognostic value of real time dobutamine stress myocardial contrast echocardiography in patients with chest pain syndrome. Int J Cardiovasc Imaging 2011; 27 Suppl 1:103-12. [PMID: 22143170 DOI: 10.1007/s10554-011-9976-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 11/02/2011] [Indexed: 11/26/2022]
Abstract
The aims of this study were (1) to evaluate the prognostic value of negative wall motion (WM) and myocardial perfusion during contrast-dobutamine stress echocardiography (DSE), (2) to determine whether WM-myocardial contrast echocardiography (MCE) had incremental prognostic value over just WM during DSE in patients with chest pain in the emergency room (ER), and (3) to compare the prognostic value of negative DSE-WM, and DSE-WM-MCE to nuclear-myocardial perfusion imaging (N-MPI) in a similar patient population over the same time period. We retrospectively studied 569 patients with real time contrast DSE, and 147 patients underwent N-MPI for evaluation of chest pain. Follow-up for cardiac events was obtained between 12 and 25 months. The cumulative cardiac event-free survival was 94.5% in negative DSE-WM, 97.1% in negative DSE-WM-MCE and 96.7% in negative N-MPI group. Cardiac event-free survival of the negative DSE-WM-MCE group was significantly higher than the DSE-WM group (log rank P < 0.01), and similar in the DSE-WM-MCE group compared to the N-MPI group. Combined WM and perfusion during DSE was the strongest independent predictor for cardiac events. The negative predictive power of DSE-WM-MCE is superior to that of just negative DSE-WM and is comparable to that of N-MPI. Myocardial perfusion and WM analysis during DSE provide independent information for predicting cardiac events in patients with chest pain syndrome in the ER.
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Affiliation(s)
- Geu-Ru Hong
- Division of Cardiology, Yeungnam University College of Medicine, Daegu, Korea
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15
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Porter TR, Adolphson M, High RR, Smith LM, Olson J, Erdkamp M, Xie F, O'Leary E, Wong BF, Eifert-Rain S, Hagen ME, Abdelmoneim SS, Mulvagh SL. Rapid Detection of Coronary Artery Stenoses With Real-Time Perfusion Echocardiography During Regadenoson Stress. Circ Cardiovasc Imaging 2011; 4:628-35. [DOI: 10.1161/circimaging.111.966341] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background—
Real-time myocardial contrast echocardiography permits the detection of myocardial perfusion abnormalities during stress echocardiography, which may improve the accuracy of the test in detecting coronary artery stenoses. We hypothesized that this technique could be used after a bolus injection of the selective A2A receptor agonist regadenoson to rapidly and safely detect coronary artery stenoses.
Methods and Results—
In 100 patients referred for quantitative coronary angiography, real-time myocardial contrast echocardiography was performed during a continuous intravenous infusion of 3% Definity at baseline and at 2-minute intervals for up to 6 minutes after a regadenoson bolus injection (400 μg). Myocardial perfusion was assessed by examination of myocardial contrast replenishment after brief high mechanical index impulses. A perfusion defect was defined as a delay (>2 seconds) in myocardial contrast replenishment in 2 contiguous segments. Wall motion was also analyzed. The overall sensitivity/specificity/accuracy for myocardial perfusion analysis in detecting a >50% diameter stenosis was 80%/74%/78%, whereas for wall motion analysis it was 60%/72%/66% (
P
<0.001 for differences in sensitivity). Sensitivity for myocardial perfusion analysis was highest on images obtained during the first 2 minutes after regadenoson bolus (
P
<0.001 compared with wall motion), whereas wall motion sensitivity was highest at the 4-to-6–minute period after the bolus. No significant side effects occurred after regadenoson bolus injection.
Conclusions—
Regadenoson real-time myocardial contrast echocardiography appears to be a feasible, safe, and rapid noninvasive method for the detection of significant coronary artery stenoses.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT0087369.
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Affiliation(s)
- Thomas R. Porter
- From the University of Nebraska Medical Center (T.R.P., M.A., R.R.H., L.M.S., J.O., M.E., F.X., E.O.), Omaha, NE, and Mayo Clinic and College of Medicine (B.F.W., S.E.-R., M.E.E., S.S.A., S.L.M.), Rochester, MN
| | - Mary Adolphson
- From the University of Nebraska Medical Center (T.R.P., M.A., R.R.H., L.M.S., J.O., M.E., F.X., E.O.), Omaha, NE, and Mayo Clinic and College of Medicine (B.F.W., S.E.-R., M.E.E., S.S.A., S.L.M.), Rochester, MN
| | - Robin R. High
- From the University of Nebraska Medical Center (T.R.P., M.A., R.R.H., L.M.S., J.O., M.E., F.X., E.O.), Omaha, NE, and Mayo Clinic and College of Medicine (B.F.W., S.E.-R., M.E.E., S.S.A., S.L.M.), Rochester, MN
| | - Lynette M. Smith
- From the University of Nebraska Medical Center (T.R.P., M.A., R.R.H., L.M.S., J.O., M.E., F.X., E.O.), Omaha, NE, and Mayo Clinic and College of Medicine (B.F.W., S.E.-R., M.E.E., S.S.A., S.L.M.), Rochester, MN
| | - Joan Olson
- From the University of Nebraska Medical Center (T.R.P., M.A., R.R.H., L.M.S., J.O., M.E., F.X., E.O.), Omaha, NE, and Mayo Clinic and College of Medicine (B.F.W., S.E.-R., M.E.E., S.S.A., S.L.M.), Rochester, MN
| | - Michelle Erdkamp
- From the University of Nebraska Medical Center (T.R.P., M.A., R.R.H., L.M.S., J.O., M.E., F.X., E.O.), Omaha, NE, and Mayo Clinic and College of Medicine (B.F.W., S.E.-R., M.E.E., S.S.A., S.L.M.), Rochester, MN
| | - Feng Xie
- From the University of Nebraska Medical Center (T.R.P., M.A., R.R.H., L.M.S., J.O., M.E., F.X., E.O.), Omaha, NE, and Mayo Clinic and College of Medicine (B.F.W., S.E.-R., M.E.E., S.S.A., S.L.M.), Rochester, MN
| | - Edward O'Leary
- From the University of Nebraska Medical Center (T.R.P., M.A., R.R.H., L.M.S., J.O., M.E., F.X., E.O.), Omaha, NE, and Mayo Clinic and College of Medicine (B.F.W., S.E.-R., M.E.E., S.S.A., S.L.M.), Rochester, MN
| | - Benjamin F. Wong
- From the University of Nebraska Medical Center (T.R.P., M.A., R.R.H., L.M.S., J.O., M.E., F.X., E.O.), Omaha, NE, and Mayo Clinic and College of Medicine (B.F.W., S.E.-R., M.E.E., S.S.A., S.L.M.), Rochester, MN
| | - Susan Eifert-Rain
- From the University of Nebraska Medical Center (T.R.P., M.A., R.R.H., L.M.S., J.O., M.E., F.X., E.O.), Omaha, NE, and Mayo Clinic and College of Medicine (B.F.W., S.E.-R., M.E.E., S.S.A., S.L.M.), Rochester, MN
| | - Mary E. Hagen
- From the University of Nebraska Medical Center (T.R.P., M.A., R.R.H., L.M.S., J.O., M.E., F.X., E.O.), Omaha, NE, and Mayo Clinic and College of Medicine (B.F.W., S.E.-R., M.E.E., S.S.A., S.L.M.), Rochester, MN
| | - Sahar S. Abdelmoneim
- From the University of Nebraska Medical Center (T.R.P., M.A., R.R.H., L.M.S., J.O., M.E., F.X., E.O.), Omaha, NE, and Mayo Clinic and College of Medicine (B.F.W., S.E.-R., M.E.E., S.S.A., S.L.M.), Rochester, MN
| | - Sharon L. Mulvagh
- From the University of Nebraska Medical Center (T.R.P., M.A., R.R.H., L.M.S., J.O., M.E., F.X., E.O.), Omaha, NE, and Mayo Clinic and College of Medicine (B.F.W., S.E.-R., M.E.E., S.S.A., S.L.M.), Rochester, MN
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16
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Fernandes DRA, Tsutsui JM, Bocchi EA, César LAM, Sbano JCN, Ramires JAF, Mathias Jr W. Qualitative and Quantitative Real Time Myocardial Contrast Echocardiography for Detecting Hibernating Myocardium. Echocardiography 2011; 28:342-9. [DOI: 10.1111/j.1540-8175.2010.01317.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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17
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Eraso LH, Reilly MP, Sehgal C, Mohler ER. Emerging diagnostic and therapeutic molecular imaging applications in vascular disease. Vasc Med 2011; 16:145-56. [PMID: 21310769 DOI: 10.1177/1358863x10392474] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Assessment of vascular disease has evolved from mere indirect and direct measurements of luminal stenosis to sophisticated imaging methods to depict millimeter structural changes of the vasculature. In the near future, the emergence of multimodal molecular imaging strategies may enable robust therapeutic and diagnostic ('theragnostic') approaches to vascular diseases that comprehensively consider structural, functional, biological and genomic characteristics of the disease in individualized risk assessment, early diagnosis and delivery of targeted interventions.This review presents a summary of recent preclinical and clinical developments in molecular imaging and theragnostic applications covering diverse atherosclerosis events such as endothelial activation, macrophage inflammatory activity, plaque neovascularization and arterial thrombosis. The main focus is on molecular targets designed for imaging platforms commonly used in clinical medicine including magnetic resonance, computed tomography and positron emission tomography. A special emphasis is given to vascular ultrasound applications, considering the important role this imaging platform plays in the clinical and research practice of the vascular medicine specialty.
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Affiliation(s)
- Luis H Eraso
- Cardiovascular Division, Vascular Medicine Section, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
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18
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Grenier N, Quaia E, Prasad PV, Juillard L. Radiology Imaging of Renal Structure and Function by Computed Tomography, Magnetic Resonance Imaging, and Ultrasound. Semin Nucl Med 2011; 41:45-60. [DOI: 10.1053/j.semnuclmed.2010.09.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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19
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Quaia E. Assessment of tissue perfusion by contrast-enhanced ultrasound. Eur Radiol 2010; 21:604-15. [PMID: 20927527 DOI: 10.1007/s00330-010-1965-6] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Revised: 08/13/2010] [Accepted: 08/17/2010] [Indexed: 12/11/2022]
Abstract
Contrast-enhanced ultrasound (CEUS) with microbubble contrast agents is a new imaging technique for quantifying tissue perfusion. CEUS presents several advantages over other imaging techniques in assessing tissue perfusion, including the use of microbubbles as blood-pool agents, portability, availability and absence of exposure to radiation or nuclear tracers. Dedicated software packages are necessary to quantify the echo-signal intensity and allow the calculation of the degree of tissue contrast enhancement based on the accurate distinction between microbubble backscatter signals and native tissue background. The measurement of organ transit time after microbubble injection and the analysis of tissue reperfusion kinetics represent the two fundamental methods for the assessment of tissue perfusion by CEUS. Transit time measurement has been shown to be feasible and has started to become accepted as a clinical tool, especially in the liver. The loudness of audio signals from spectral Doppler analysis is used to generate time-intensity curves to follow the wash-in and wash-out of the microbubble bolus. Tissue perfusion may be quantified also by analysing the replenishment kinetics of the volume of microbubbles after their destruction in the imaged slice. This allows to obtain semiquantitative parameters related to local tissue perfusion, especially in the heart, brain, and kidneys.
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Affiliation(s)
- Emilio Quaia
- Department of Radiology, Cattinara Hospital, University of Trieste, Strada di Fiume 447, Trieste, 34149, Italy.
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20
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Porter TR, Xie F. Myocardial perfusion imaging with contrast ultrasound. JACC Cardiovasc Imaging 2010; 3:176-87. [PMID: 20159645 DOI: 10.1016/j.jcmg.2009.09.024] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Revised: 08/06/2009] [Accepted: 09/17/2009] [Indexed: 10/19/2022]
Abstract
This report reviews the development and clinical application of myocardial perfusion imaging with myocardial contrast echocardiography (MCE). This includes the development of microbubble formulations that permit the detection of left ventricular contrast from venous injection and the imaging techniques that have been invented to detect the transit of these microbubbles through the microcirculation. The methods used to quantify myocardial perfusion during a continuous infusion of microbubbles are described. A review of the clinical studies that have examined the clinical utility of myocardial perfusion imaging with MCE during rest and stress echocardiography is then presented. The limitations of MCE are also discussed.
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Affiliation(s)
- Thomas R Porter
- University of Nebraska Medical Center, Cardiology,981165 Nebraska Medical Center, Omaha, Nebraska 68198-1165, USA.
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21
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Impact of previous myocardial infarction on the incremental value of myocardial contrast to two-dimensional supine bicycle stress echocardiography in evaluation of coronary artery disease. Int J Cardiol 2010; 136:47-55. [PMID: 18675474 DOI: 10.1016/j.ijcard.2008.04.072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2007] [Revised: 01/30/2008] [Accepted: 04/23/2008] [Indexed: 12/16/2022]
Abstract
BACKGROUND If compared to two-dimensional echocardiography (2DE), myocardial contrast echocardiography (MCE) improves detection of coronary artery disease (CAD) during pharmacological stress, but data on MCE vs. 2DE during supine bicycle stress is limited. Although previous myocardial infarction (MI) influences sensitivity of 2DE, its effect on MCE has not been evaluated. OBJECTIVES The study sought to determine the incremental benefit of MCE over 2DE for evaluation of CAD during supine bicycle stress and to assess the impact of previous MI on diagnostic values of both methods. METHODS We studied 103 consecutive patients scheduled for coronary angiography. Prior to coronary angiography, all patients underwent supine bicycle stress. 2DE and MCE were performed during this stress test. The diagnosis of obstructive CAD (> or =50% stenosis) was based on the presence of inducible wall motion and perfusion abnormalities. RESULTS Quantitative coronary angiography revealed > or =50% stenosis in 53 of 77 patients without previous MI and in 21 of 26 patients with previous MI. If compared to 2DE, MCE was more sensitive (68% vs. 86%; p<0.001) and more accurate (73% vs. 86%; p < 0.001) to detect > or =50% stenosis. In patients without previous MI, 2DE and MCE yielded sensitivity of 65% and 85% (p < 0.01) and accuracy of 71% and 85% (p < 0.01), whereas in patients with previous MI sensitivity was 79% and 90% (p=NS) and accuracy 79% and 88% (p = NS), respectively. CONCLUSIONS MCE enhances sensitivity and accuracy of 2DE in detection of obstructive CAD during supine bicycle stress. The incremental benefit of MCE is especially present in patients without previous MI.
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22
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Analysis of regional wall motion during contrast-enhanced dobutamine stress echocardiography: effect of contrast imaging settings. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2009; 10:956-60. [DOI: 10.1093/ejechocard/jep112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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23
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Miszalski-Jamka T, Kuntz-Hehner S, Schmidt H, Peter D, Miszalski-Jamka K, Hammerstingl C, Tiemann K, Ghanem A, Troatz C, Pasowicz M, Lüderitz B, Omran H. Myocardial Contrast Echocardiography Enhances Long-Term Prognostic Value of Supine Bicycle Stress Two-Dimensional Echocardiography. J Am Soc Echocardiogr 2009; 22:1220-7. [DOI: 10.1016/j.echo.2009.07.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2008] [Indexed: 11/25/2022]
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24
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Sinusas AJ, Bengel F, Nahrendorf M, Epstein FH, Wu JC, Villanueva FS, Fayad ZA, Gropler RJ. Multimodality cardiovascular molecular imaging, part I. Circ Cardiovasc Imaging 2009; 1:244-56. [PMID: 19808549 DOI: 10.1161/circimaging.108.824359] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In Part I of this consensus article, the imaging methodology, evolving imaging technology, and development of novel targeted molecular probes relevant to the developing field of cardiovascular molecular imaging were reviewed. Novel reporter gene and reporter probe imaging approaches for tracking of cardiac transgene expression were also discussed and have important future implications for evaluation of gene- and cell-based therapies for the failing heart. The current role of metabolic and receptor imaging was also briefly reviewed, as these represent the beginning of our clinical application of molecular imaging within the cardiovascular system. Part II will summarize the available targeted imaging probes as well as specific future applications of molecular imaging for identification and evaluation of critical pathophysiological processes of the cardiovascular system.
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Affiliation(s)
- Albert J Sinusas
- Yale University School of Medicine, New Haven, CT 06520-8017, USA.
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25
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Xie F, Dodla S, O'Leary E, Porter TR. Detection of subendocardial ischemia in the left anterior descending coronary artery territory with real-time myocardial contrast echocardiography during dobutamine stress echocardiography. JACC Cardiovasc Imaging 2009; 1:271-8. [PMID: 19356438 DOI: 10.1016/j.jcmg.2008.02.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2007] [Revised: 02/20/2008] [Accepted: 02/28/2008] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The purpose of this study was to test whether the transmural delineation of myocardial perfusion during dobutamine stress imaging with real-time myocardial contrast echocardiography (RTMCE) might permit visualization of dobutamine-induced subendocardial ischemia. BACKGROUND Significant coronary artery disease can be present despite normal transmural wall thickening (WT) responses during dobutamine stress echocardiography (DSE). One potential reason is dobutamine-induced recruitment of epicardial WT in the presence of subendocardial ischemia. METHODS Myocardial perfusion and WT were examined with RTMCE during DSE with a continuous infusion of ultrasound contrast in 94 patients with normal resting WT. Fifty-five of the patients had a >50% diameter stenosis in the left anterior descending coronary artery (LAD). The WT was visually assessed by a blinded reviewer at 2 time periods: initially after a high mechanical index impulse before myocardial contrast replenishment (MCR), and again during MCR. Subendocardial %WT was measured during MCR, if a subendocardial perfusion defect was visually evident, whereas transmural WT was quantified on the pre-MCR images. RESULTS Fifty patients (91%) with LAD stenoses exhibited a myocardial contrast defect at peak stress, with 45 defects being subendocardial. Transmural WT pre-MCR appeared normal in 35 of the 45 patients with subendocardial perfusion defects (78%). However, a subendocardial WT abnormality was apparent during MCR in 18 of these 35 patients, even though transmural WT was not different from the 17 patients with normal subendocardial WT (33 +/- 15% vs. 36 +/- 14%). Quantitative measurements of WT within the subendocardium were significantly less in the patients with visually evident subendocardial WT abnormalities, when compared with those who seemed to have normal WT during MCR (17 +/- 8% vs. 25 +/- 10%, p < 0.01). CONCLUSIONS In patients with significant LAD disease, RTMCE during DSE detects subendocardial ischemia even when transmural WT appears normal. Real-time myocardial contrast echocardiography should be the preferred ultrasound imaging method when using contrast to detect coronary artery disease during DSE.
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Affiliation(s)
- Feng Xie
- Department of Internal Medicine, Section of Cardiology, University of Nebraska Medical Center, Omaha, NE 68198, USA
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26
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American Society of Echocardiography Consensus Statement on the Clinical Applications of Ultrasonic Contrast Agents in Echocardiography. J Am Soc Echocardiogr 2009; 21:1179-201; quiz 1281. [PMID: 18992671 DOI: 10.1016/j.echo.2008.09.009] [Citation(s) in RCA: 312] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
UNLABELLED ACCREDITATION STATEMENT: The American Society of Echocardiography (ASE) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The ASE designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit.trade mark Physicians should only claim credit commensurate with the extent of their participation in the activity. The American Registry of Diagnostic Medical Sonographers and Cardiovascular Credentialing International recognize the ASE's certificates and have agreed to honor the credit hours toward their registry requirements for sonographers. The ASE is committed to resolving all conflict-of-interest issues, and its mandate is to retain only those speakers with financial interests that can be reconciled with the goals and educational integrity of the educational program. Disclosure of faculty and commercial support sponsor relationships, if any, have been indicated. TARGET AUDIENCE This activity is designed for all cardiovascular physicians, cardiac sonographers, and nurses with a primary interest and knowledge base in the field of echocardiography; in addition, residents, researchers, clinicians, sonographers, and other medical professionals having a specific interest in contrast echocardiography may be included. OBJECTIVES Upon completing this activity, participants will be able to: 1. Demonstrate an increased knowledge of the applications for contrast echocardiography and their impact on cardiac diagnosis. 2. Differentiate the available ultrasound contrast agents and ultrasound equipment imaging features to optimize their use. 3. Recognize the indications, benefits, and safety of ultrasound contrast agents, acknowledging the recent labeling changes by the US Food and Drug Administration (FDA) regarding contrast agent use and safety information. 4. Identify specific patient populations that represent potential candidates for the use of contrast agents, to enable cost-effective clinical diagnosis. 5. Incorporate effective teamwork strategies for the implementation of contrast agents in the echocardiography laboratory and establish guidelines for contrast use. 6. Use contrast enhancement for endocardial border delineation and left ventricular opacification in rest and stress echocardiography and unique patient care environments in which echocardiographic image acquisition is frequently challenging, including intensive care units (ICUs) and emergency departments. 7. Effectively use contrast echocardiography for the diagnosis of intracardiac and extracardiac abnormalities, including the identification of complications of acute myocardial infarction. 8. Assess the common pitfalls in contrast imaging and use stepwise, guideline-based contrast equipment setup and contrast agent administration techniques to optimize image acquisition.
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27
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Gebker R, Jahnke C, Manka R, Hamdan A, Schnackenburg B, Fleck E, Paetsch I. Additional Value of Myocardial Perfusion Imaging During Dobutamine Stress Magnetic Resonance for the Assessment of Coronary Artery Disease. Circ Cardiovasc Imaging 2008; 1:122-30. [PMID: 19808529 DOI: 10.1161/circimaging.108.779108] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Rolf Gebker
- From the German Heart Institute Berlin, Germany
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28
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Wasmeier GH, Zimmermann WH, Schineis N, Melnychenko I, Voigt JU, Eschenhagen T, Flachskampf FA, Daniel WG, Nixdorff U. Real-time myocardial contrast echocardiography for assessing perfusion and function in healthy and infarcted wistar rats. ULTRASOUND IN MEDICINE & BIOLOGY 2008; 34:47-55. [PMID: 17854980 DOI: 10.1016/j.ultrasmedbio.2007.06.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2006] [Revised: 06/22/2007] [Accepted: 06/22/2007] [Indexed: 05/17/2023]
Abstract
Real-time myocardial contrast echocardiography (MCE) is a noninvasive perfusion imaging method, whereas technical and resolution problems impair its application in small animals. Hence, we investigated the feasibility of MCE in experimental cardiovascular set-ups involving healthy and infarcted myocardium in rats. Twenty-five male Wistar rats were examined under volatile anesthesia (2.5% isoflurane) with high-resolution conventional 2-D echocardiography (2DE) and real-time MCE (Sonos 7,500 with 15MHz-transducer, Philips Medical Systems, Andover, MA, USA) in short-axis view. Contrast agent (SonoVue, Bracco, Milan, Italy) was infused as a bolus into a sublingual vein. Background-subtracted contrast signal intensity (SI) was measured off-line in six end-systolic segments and fitted to an exponential curve (gamma variate). Derived peak SI was subsequently calculated and compared with wall motion and common functional measured quantities (left ventricular end-diastolic diameter [LVEDD], area shortening [AS]). Recordings were performed before and 14 days after left anterior descending (LAD) ligature. Infarction induced anterior wall motion abnormalities (WMA) in all animals (16 akinetic, 9 hypokinetic), increased LVEDD (9.1 +/- 0.6 vs. 7.9 +/- 0.6 mm, p < 0.001), reduced AS (36.1 +/- 10.0 vs. 59.5 +/- 4.1%, p < 0.001) and reduced anterior segmental SI (0.4 +/- 0.4 dB akinetic / 1.7 +/- 1.7 dB hypokinetic vs. 15.8 +/- 10.9 dB preinfarct, p < 0.001 / p < 0.001). Segmental SI in normokinetic segments remained unchanged. Area at risk (perfusion defect) correlated well with WMA (r = 0.838). These data confirmed high-resolution real-time MCE as a rational tool for assessing myocardial perfusion of Wistar rats. It may therefore be a useful diagnostic tool for in-vivo cardiovascular research in small animals.
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Affiliation(s)
- Gerald H Wasmeier
- Second Medical Clinic, Friedrich Alexander University, Erlangen-Nuremberg, Germany
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29
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Xie F, Hankins J, Mahrous HA, Porter TR. Detection of Coronary Artery Disease with a Continuous Infusion of Definity Ultrasound Contrast during Adenosine Stress Real Time Perfusion Echocardiography. Echocardiography 2007; 24:1044-50. [DOI: 10.1111/j.1540-8175.2007.00543.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Ishikura F, Hirayama H, Toshida T, Iwata A, Otani K, Asanuma T, Beppu S. Three-dimensional reconstruction of coronary arteriole plexus image by contrast echocardiography using a high-frequency transducer. J Am Soc Echocardiogr 2007; 21:770-4. [PMID: 17904808 DOI: 10.1016/j.echo.2007.08.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2007] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study was established to examine the efficacy of a high-frequency liner probe for visualizing fine anatomy of coronary microcirculation. METHODS The vessel size and its velocity-time integral at the anterior wall in dogs by real-time contrast echocardiography with high-frequency liner probe and pulse Doppler methods, and the coronary flow volume, were measured before and after adenosine triphosphate injection. A 3-dimensional (3D) image was reconstructed by the built-in 3D system using intermittent flash echocardiographic images. RESULTS The increments of flow volume calculated from vessel sizes and velocity-time integral were well correlated with those of coronary flow volume. Using intermittent flash echocardiographic images, fine dots and lines of contrast echocardiographic-expected arterioles were evident, and easily and quickly reconstructed as coronary plexus by 3D system. CONCLUSION A high-frequency liner probe provides the fine-vessel images to evaluate those morphologic changes; a 3D reconstruction image could provide new information about coronary arterioles.
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Affiliation(s)
- Fuminobu Ishikura
- School of Allied Health Sciences, Osaka University, Faculty of Medicine, Osaka, Japan.
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Porter TR, Xie F. Emerging cardiovascular imaging techniques to non-invasively detect coronary artery disease. EXPERT OPINION ON MEDICAL DIAGNOSTICS 2007; 1:203-211. [PMID: 23489307 DOI: 10.1517/17530059.1.2.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The current reference standard for the non-invasive detection of coronary artery disease (CAD) in patients who present with symptoms suggestive of CAD is either an exercise or pharmacologic stress radionuclide examination. Although useful, this test is limited by its relatively poor spatial resolution, high cost and need for ionizing radiation. Alternative non-invasive tests that are now clinically available include rest or pharmacologic stress echocardiography, pharmacologic stress during magnetic resonance perfusion imaging and multislice computed tomographic coronary angiography. This paper will present the advantages and disadvantages of stress techniques, and new developments that will further improve the accuracy of these tests.
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Affiliation(s)
- Thomas R Porter
- University of Nebraska Medical Center, Department of Internal Medicine, Section of Cardiology, 982265 Nebraska, Omaha, NE 68198-2265, USA +1 402 559 8150 ;
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Ishikura F, Otani K, Kayano H, Toshida T, Iwata A, Asanuma T, Kitakaze M, Shinozaki Y, Mori H, Beppu S. Quantitative assessment of microcollateral recruitment during coronary occlusion using real-time intravenous myocardial contrast echocardiography. J Am Soc Echocardiogr 2007; 21:139-45. [PMID: 17628411 DOI: 10.1016/j.echo.2007.05.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2004] [Indexed: 11/30/2022]
Abstract
BACKGROUND Residual collateral-derived myocardial blood flow (MBF) (A x beta) is important to protect against myocardial ischemia after acute coronary occlusion. METHODS Recruitment of microcollateral was assessed in 22 dogs with left circumflex coronary artery occlusion by analysis of MBF and regional wall thickening (WT) using real-time myocardial contrast echocardiography. RESULTS Video intensity and WT at the center of risk area were significantly lower than those at the border of risk area. The video intensity, A value, beta value, and MBF correlated well with WT after left circumflex coronary artery occlusion. The WT of the area with above 25% of normal MBF was preserved and was higher than that at below 25%. However, the deterioration of WT was not distinguished according to A value. CONCLUSION Real-time myocardial contrast echocardiography is a useful noninvasive method to evaluate collateral-derived MBF, which can be a reliable index of protection against myocardial ischemia.
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Affiliation(s)
- Fuminobu Ishikura
- School of Allied Health Sciences, Osaka University, Faculty of Medicine, Osaka, Japan.
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Miszalski-Jamka T, Kuntz-Hehner S, Schmidt H, Hammerstingl C, Tiemann K, Ghanem A, Troatz C, Lüderitz B, Omran H. Real Time Myocardial Contrast Echocardiography During Supine Bicycle Stress and Continuous Infusion of Contrast Agent. Cutoff Values for Myocardial Contrast Replenishment Discriminating Abnormal Myocardial Perfusion. Echocardiography 2007; 24:638-48. [PMID: 17584204 DOI: 10.1111/j.1540-8175.2007.00442.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Myocardial contrast echocardiography (MCE) is a new imaging modality for diagnosing coronary artery disease (CAD). OBJECTIVE The aim of our study was to evaluate feasibility of qualitative myocardial contrast replenishment (RP) assessment during supine bicycle stress MCE and find out cutoff values for such analysis, which could allow accurate detection of CAD. METHODS Forty-four consecutive patients, scheduled for coronary angiography (CA) underwent supine bicycle stress two-dimensional echocardiography (2DE). During the same session, MCE was performed at peak stress and post stress. Ultrasound contrast agent (SonoVue) was administered in continuous mode using an infusion pump (BR-INF 100, Bracco Research). Seventeen-segment model of left ventricle was used in analysis. MCE was assessed off-line in terms of myocardial contrast opacification and RP. RP was evaluated on the basis of the number of cardiac cycles required to refill the segment with contrast after its prior destruction with high-power frames. Determination of cutoff values for RP assessment was performed by means of reference intervals and receiver operating characteristic analysis. Quantitative CA was carried out using CAAS system. RESULTS MCE could be assessed in 42 patients. CA revealed CAD in 25 patients. Calculated cutoff values for RP-analysis (peak-stress RP >3 cardiac cycles and difference between peak stress and post stress RP >0 cardiac cycles) provided sensitive (88%) and accurate (88%) detection of CAD. Sensitivity and accuracy of 2DE were 76% and 79%, respectively. CONCLUSIONS Qualitative RP-analysis based on the number of cardiac cycles required to refill myocardium with contrast is feasible during supine bicycle stress MCE and enables accurate detection of CAD.
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Kowatsch I, Tsutsui JM, Osório AFF, Uchida AH, Machiori GGA, Lopes ML, César LAM, Ramires JAF, Mathias W. Head-to-head comparison of dobutamine and adenosine stress real-time myocardial perfusion echocardiography for the detection of coronary artery disease. J Am Soc Echocardiogr 2007; 20:1109-17. [PMID: 17566697 DOI: 10.1016/j.echo.2007.02.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2006] [Indexed: 10/23/2022]
Abstract
We sought to determine the value of dobutamine versus adenosine real-time myocardial perfusion (MP) echocardiography for detecting coronary artery disease and the value of quantitative analysis of MP over electrocardiography, wall motion, and qualitative MP. We studied 54 patients by real-time MP echocardiography and coronary angiography. Replenishment velocity (beta) and an index of myocardial blood flow (A(n)xbeta) were derived from quantitative MP. During dobutamine stress, beta (1.7 +/- 0.7 vs 2.7 +/- 1.2; P < .001) and A(n)xbeta (2.2 +/- 1.0 vs 3.5 +/- 1.6; P < .001) reserves were lower in patients with coronary artery disease. The same was observed with adenosine for beta (1.7 +/- 0.8 vs 2.5 +/- 1.1; P < .001) and A(n)xbeta (1.9 +/- 0.7 vs 3.2 +/- 1.4; P < .001) reserves. Accuracy of electrocardiography, wall motion, qualitative MP, and quantitative MP were 61%, 76%, 76%, and 80% for dobutamine and 70%, 70%, 76%, and 80% for adenosine, respectively. Quantitative MP had incremental diagnostic value over other variables during dobutamine (chi(2) 23.7-38.4; P < .001) and adenosine (chi(2) 26.7-59.4; P < .001). In conclusion, dobutamine and adenosine real-time MP echocardiography hold similar accuracy for detecting coronary artery disease. Quantitative MP provides incremental diagnostic information over other variables.
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Affiliation(s)
- Ingrid Kowatsch
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
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Yoshifuku S, Chen S, McMahon E, Korinek J, Yoshikawa A, Ochiai I, Sengupta PP, Belohlavek M. Parametric detection and measurement of perfusion defects in attenuated contrast echocardiographic images. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2007; 26:739-48. [PMID: 17526605 DOI: 10.7863/jum.2007.26.6.739] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVE Attenuation of radio frequency (RF) signals limits the use of contrast echocardiography. The harmonic-to-fundamental ratio (HFR) of the RF signals compensates for attenuation. We tested whether HFR analysis measures the left ventricular nonperfused area under simulated experimental attenuation. METHODS Radio frequency image data from short axis systolic projections were obtained from 11 open-chest dogs with left anterior descending or left circumflex coronary artery occlusion followed by left atrial bolus injection of a perflutren microbubble contrast agent. Clinical attenuation was simulated by calibrated silicone pads interposed between the epicardial surface and the transducer to induce mild (7-dB) and severe (14-dB) reduction of the backscattered RF signals. Harmonic-to-fundamental ratio values were calculated for each image pixel for 0-, 7-, and 14-dB attenuation conditions and reproducibly showed a "perfused area" and a "nonperfused area." A reference nonperfused area was obtained by manual delineation in high-quality contrast scans. RESULTS Correlations of the HFR-detected and manually outlined perfusion defect areas were R = 0.92 for 0 dB, R = 0.94 for 7 dB, and R = 0.90 for 14 dB; the mean difference was less than 0.36 cm(2) (negligible) in all 3 attenuation settings. Conclusions. Attenuation compensation by our HFR method allows precise measurement of myocardial perfusion defect areas in contrast scans with simulated high level of attenuation.
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Affiliation(s)
- Shiro Yoshifuku
- Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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Osório AFF, Tsutsui JM, Kowatsch I, Guerra VC, Ramires JAF, Lemos PA, Cesar LAM, Mathias W. Evaluation of Blood Flow Reserve in Left Anterior Descending Coronary Artery Territory by Quantitative Myocardial Contrast and Doppler Echocardiography. J Am Soc Echocardiogr 2007; 20:709-16. [PMID: 17543741 DOI: 10.1016/j.echo.2006.11.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2006] [Indexed: 11/26/2022]
Abstract
We sought to compare the feasibility and accuracy of myocardial blood flow reserve (MBFR) measured by quantitative real-time myocardial contrast echocardiography with those of coronary flow velocity reserve (CFVR) obtained by transthoracic Doppler echocardiography for detecting left anterior descending coronary artery (LAD) stenosis. We studied 71 patients who underwent adenosine stress contrast echocardiography, transthoracic Doppler echocardiography, and quantitative coronary angiography within 1 month. An index of myocardial blood flow (A x beta) was determined by quantification of peak plateau acoustic intensity (A) and microbubble replenishment velocity (beta) by contrast echocardiography. Feasibilities of qualitative analysis of myocardial perfusion, and CFVR and MBFR measurements were 98%, 83%, and 94%, respectively. Patients with LAD stenosis had lower CFVR (1.1 +/- 0.4 vs 2.7 +/- 0.8, P < .001), MBFR (1.2 +/- 0.5 vs 2.5 +/- 0.8, P < .001), and beta reserve (1.1 +/- 0.5 vs 2.4 +/- 0.6, P < .001) than those without lesion. Sensitivities, specificities, and accuracies for detecting LAD stenosis were 64%, 93%, and 80% for qualitative analysis of myocardial perfusion; 92%, 94%, and 93% for CFVR; 84%, 87%, and 86% for MBFR; and 80%, 97%, and 89% for beta reserve. In this selected study population, CFVR was the best index for detecting LAD stenosis (odds ratio = 1.78, 95% confidence interval = 1.28-2.47).
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Abstract
Myocardial contrast echocardiography (MCE) is a noninvasive imaging technique that relies on the ultrasound detection of microbubble contrast agents. These agents are confined to the intravascular space thereby producing signal enhancement from the blood pool. This review encompasses many of the key concepts regarding the clinical application of MCE. The first section focuses on the composition, safety, and biokinetics of ultrasound contrast agents. Then we discuss new ultrasound imaging methodology that has been developed to enhance detection of contrast agent and to assess perfusion at the tissue level. Next, the clinical applications of contrast ultrasound are reviewed. These include enhancement of the cardiac chambers for better assessment of cardiac function and masses, myocardial perfusion imaging for the detection of coronary artery disease, and the assessment of myocardial viability and microvascular reflow. Finally, we discuss some of the future applications for MCE, which include molecular imaging of disease and drug/gene delivery. The overall aim of the review is to update the clinician on state-of-the-art MCE and how it can be applied in patients with cardiovascular disease.
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Dounis V, Siegmund T, Hansen A, Jensen J, Schumm-Draeger PM, von Bibra H. Global myocardial perfusion and diastolic function are impaired to a similar extent in patients with type 2 diabetes mellitus and in patients with coronary artery disease--evaluation by contrast echocardiography and pulsed tissue Doppler. Diabetologia 2006; 49:2729-40. [PMID: 17016696 DOI: 10.1007/s00125-006-0398-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2006] [Accepted: 06/19/2006] [Indexed: 01/03/2023]
Abstract
AIMS/HYPOTHESIS Using modern echocardiography, we quantified the extent of global myocardial function and perfusion abnormalities in patients with type 2 diabetes and compared this with the hypothetically similar extent of impairments in patients with coronary artery disease (CAD). SUBJECTS AND METHODS This case-control study (66 patients) compared four age-matched groups: control, type 2 diabetic, CAD, and diabetic subjects with CAD (DCAD) and left ventricular ejection fraction >50%. CAD patients had 1-2 vessel disease. Diastolic and systolic myocardial velocities were assessed with pulsed tissue Doppler. Global myocardial perfusion was assessed with contrast echocardiography as indices of capillary blood volume and myocardial blood flow at maximal vasodilatation. In CAD and DCAD patients, functional and perfusion parameters were additionally assessed in the territory with a normal coronary angiogram reading, providing a model for comparison with the global data from control and diabetic patients. RESULTS Comparing diabetic with control subjects, myocardial velocity at early diastole was impaired (8.8+/-1.8 vs 10.1+/-1.7 cm/s; p=0.02) and correlated inversely with age, HbA(1c) and pulse pressure (R (2)=0.761). Capillary blood volume (16.6+/-5.0 vs 24.4+/-4.9%) and blood flow (56+/-35 vs 114+/-40) were decreased (p=0.001). In CAD patients, myocardial velocity at early diastole was similarly decreased (p=0.02). CAD and DCAD patients were receiving more cardiovascular preventive therapy for the same extent of impaired global perfusion as in the less extensively treated diabetes group without CAD (p<0.002), but had superior perfusion of the 'normal' coronary territory than that group (p<0.05). CONCLUSIONS/INTERPRETATION In patients with diabetes, global diastolic function and myocardial capillary blood volume and blood flow are impaired to the same extent as in patients with CAD. These impairments could form the basis of new therapeutic concepts.
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Affiliation(s)
- V Dounis
- Department of Cardiology, General Air Force Hospital, Athens, Greece
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Firschke C, Andrássy P, Linka AZ, Busch R, Martinoff S. Adenosine myocardial contrast echo in intermediate severity coronary stenoses: a prospective two-center study. Int J Cardiovasc Imaging 2006; 23:311-21. [PMID: 17006730 DOI: 10.1007/s10554-006-9157-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2006] [Accepted: 08/25/2006] [Indexed: 01/18/2023]
Abstract
BACKGROUND We sought to evaluate the role of adenosine myocardial contrast echocardiography (MCE) for the determination of functional relevance of coronary stenoses with intermediate angiographic severity and compared the results to single photon imaging (SPECT). We hypothezised that sole assessment of myocardial blood volume changes during adenosine on MCE would indicate functional stensosis relevance when accompanied by increased myocardial oxygen consumption (MVO2). METHODS Fifty-seven patients with >or=1 coronary stenosis underwent adenosine MCE (ultraharmonic imaging) and exercise SPECT. On MCE, myocardial blood volume was assessed and constant or increased myocardial opacification during adenosine coupled with increased MVO2 was defined as normal and decreased opacification as abnormal. RESULTS Rate-pressure product significantly increased during adenosine in all patients due to reflex tachycardia following mild hypotension, indicative of increased MVO2. Concordance between MCE and SPECT for the detection of reversible myocardial perfusion defects was 89% (kappa = 0.83). Comparison of regions between rest and during adenosine as opposed to comparison to remote regions of the same stage was important for accurate assessment because concordance betweenn MCE and SPECT was less on separate assessment at rest (73%, kappa = 0.40) compared to stress (91%, kappa = 0.81, P < 0.05) mainly due to territories scored normal on SPECT and abnormal on MCE. CONCLUSIONS Assessment of myocardial blood volume changes during adenosine using MCE can be used for the determination of the functional relevance of coronary stenoses of intermediate angiographic severity if MVO2 is increased during adenosine.
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Affiliation(s)
- Christian Firschke
- Deutsches Herzzentrum, Technische Universität München, München, Germany.
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Lin SL, Chiou KR, Huang WC, Peng NJ, Tsay DG, Liu CP. Detection of coronary artery disease using real-time myocardial contrast echocardiography: a comparison with dual-isotope resting thallium-201/stress technectium-99m sestamibi single-photon emission computed tomography. Heart Vessels 2006; 21:226-35. [PMID: 16865298 DOI: 10.1007/s00380-005-0890-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2004] [Accepted: 11/26/2005] [Indexed: 10/24/2022]
Abstract
Real-time myocardial contrast echocardiography (MCE) has the potential to evaluate myocardial perfusion and wall motion (WM) simultaneously. The purposes of this study were to correlate the diagnostic value of MCE with radionuclide single-photon emission computed tomography (SPECT), and to assess the sensitivity and specificity of real-time MCE in detecting coronary artery disease (CAD). Seventy patients with clinically suspected CAD underwent MCE and SPECT at baseline and after dipyridamole infusion. Segmental perfusion with MCE using low mechanical index after 0.3-0.4-ml bolus injections of perfluorocarbon exposed sonicated dextrose albumin solution was performed. All patients had a dual-isotope (rest thallium-201, stress sestamibi) study performed both at baseline and after dipyridamole infusion, and 40 patients had subsequent quantitative coronary angiography. Abnormalities were noted in 27 patients (38.6%) by MCE, in 29 patients (41.4%) by WM analysis, and in 30 patients (42.9%) by SPECT imaging. When MCE and WM analysis were combined, the agreement with SPECT imaging improved from 75.7% (Kappa = 0.50) to 82.0% (Kappa = 0.62). In 40 patients (120 territories) who underwent coronary angiography, good perfusion concordance was achieved for the left anterior descending and left circumflex arteries, and was fair for the right coronary arteries. Compared with quantitative angiography, there was no difference in sensitivity, specificity, and accuracy in detecting significant CAD among the three modalities. The combination of MCE and WM had a better sensitivity (84%), specificity (93.3%), and accuracy (87.5%) than the MCE and WM analysis alone. However, the difference did not reach statistical significance. Real-time MCE has a good agreement with SPECT imaging for detecting CAD. The combination of MCE and WM appears to have higher sensitivity, specificity, and accuracy in detecting CAD than either technique alone.
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Affiliation(s)
- Shoa-Lin Lin
- Department of Internal Medicine, Division of Cardiology, Kaohsiung Veterans General Hospital, 386 Dar-Chung 1st Road, Kaohsiung, 813, Taiwan.
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Dourado PMM, Tsutsui JM, Santos JMT, Aiello VD, Mathias W, Ramires JAF, da Luz PL, Chagas ACP. Bioeffects of albumin-encapsulated microbubbles and real-time myocardial contrast echocardiography in an experimental canine model. Braz J Med Biol Res 2006; 39:825-32. [PMID: 16751990 DOI: 10.1590/s0100-879x2006000600017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Myocardial contrast echocardiography has been used for assessing myocardial perfusion. Some concerns regarding its safety still remain, mainly regarding the induction of microvascular alterations. We sought to determine the bioeffects of microbubbles and real-time myocardial contrast echocardiography (RTMCE) in a closed-chest canine model. Eighteen mongrel dogs were randomly assigned to two groups. Nine were submitted to continuous intravenous infusion of perfluorocarbon-exposed sonicated dextrose albumin (PESDA) plus continuous imaging using power pulse inversion RTMCE for 180 min, associated with manually deflagrated high-mechanical index impulses. The control group consisted of 3 dogs submitted to continuous imaging using RTMCE without PESDA, 3 dogs received PESDA alone, and 3 dogs were sham-operated. Hemodynamics and cardiac rhythm were monitored continuously. Histological analysis was performed on cardiac and pulmonary tissues. No hemodynamic changes or cardiac arrhythmias were observed in any group. Normal left ventricular ejection fraction and myocardial perfusion were maintained throughout the protocol. Frequency of mild and focal microhemorrhage areas in myocardial and pulmonary tissue was similar in PESDA plus RTMCE and control groups. The percentages of positive microscopical fields in the myocardium were 0.4 and 0.7% (P = NS) in the PESDA plus RTMCE and control groups, respectively, and in the lungs they were 2.1 and 1.1%, respectively (P = NS). In this canine model, myocardial perfusion imaging obtained with PESDA and RTMCE was safe, with no alteration in cardiac rhythm or left ventricular function. Mild and focal myocardial and pulmonary microhemorrhages were observed in both groups, and may be attributed to surgical tissue manipulation.
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Affiliation(s)
- P M M Dourado
- Laboratório de Investigação em Isquemia Miocárdica, Unidade Clínica de Aterosclerose, Faculdade de Medicina, Universidade de São Paulo, SP, Brasil.
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Malm S, Frigstad S, Torp H, Wiseth R, Skjarpe T. Quantitative Adenosine Real-time Myocardial Contrast Echocardiography for Detection of Angiographically Significant Coronary Artery Disease. J Am Soc Echocardiogr 2006; 19:365-72. [PMID: 16581474 DOI: 10.1016/j.echo.2005.10.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2005] [Indexed: 10/24/2022]
Abstract
BACKGROUND Real-time (RT) myocardial contrast echocardiography (MCE) is a novel method for assessment of regional myocardial perfusion. We sought to evaluate the feasibility and diagnostic accuracy of quantitative adenosine RT MCE in predicting significant coronary stenoses, with reference to quantitative coronary angiography. METHODS Low-power RT MCE was performed in 43 patients scheduled for quantitative coronary angiography. Peak signal intensity (A), rate of signal intensity increase (beta), A x beta (myocardial blood flow), and their hyperemic reserves were estimated and compared with angiographic data. RESULTS The feasibility of quantitative stress RT MCE covering all coronary territories was 77% of patients with adequate baseline image quality. At rest we found no significant difference for any of the perfusion parameters between the normal and stenosed coronary territories. During hyperemia, beta and A x beta, but not A, increased significantly in normal coronary territories. In the regions subtended by significantly stenosed arteries, there were no significant increases in beta and A x beta. Receiver operating characteristic curves indicated that beta- and A x beta-reserves, but not A-reserve, could be sensitive parameters for detecting flow-limiting coronary stenosis in selected patients, particularly if significant left anterior descending coronary artery disease was involved. CONCLUSION Quantitative assessment of myocardial blood flow and its velocity reserve by RT MCE has the potential to detect significant coronary artery disease, but because of imaging and technical problems it is not yet robust enough for clinical use in unselected patients.
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Affiliation(s)
- Siri Malm
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
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Tsutsui JM, Mukherjee S, Elhendy A, Xie F, Lyden ER, O'Leary E, McGrain AC, Porter TR. Value of dobutamine stress myocardial contrast perfusion echocardiography in patients with advanced liver disease. Liver Transpl 2006; 12:592-9. [PMID: 16555336 DOI: 10.1002/lt.20651] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Although dobutamine stress echocardiography has been used for the preoperative evaluation of patients with advanced liver disease (ALD), no data exist regarding the value of myocardial perfusion imaging (MPI) with real-time myocardial contrast echocardiography (RTMCE) in this patient population. We sought to determine the value of MPI during dobutamine stress RTMCE for predicting prognosis in patients with ALD. We examined both wall motion and MPI in 230 patients with ALD who underwent dobutamine stress RTMCE using intravenous commercially available contrast agents (Optison, GE-Amersham, Princeton, NJ; or Definity, Bristol-Myers Squibb Medical Imaging, North Billerica, MA). The prognostic value of clinical variables, including the Model for End-Stage Liver Disease (MELD) score, and echocardiographic data were examined using a Cox Hazard model. The primary endpoint was mortality of all causes. Among the 85 patients who underwent orthotopic liver transplantation, 4 had abnormal MPI and 81 had normal perfusion. The hospital mortality rate was 50% (2/4) in patients with abnormal MPI and 2% (2/81) in patients with normal MPI (P = 0.01). Among patients with abnormal MPI, 1 died from myocardial infarction in the first postoperative day and the second 1 from hemorrhagic shock. During a median follow-up of 15 months, 53 (23%) patients died. The independent predictors of death were an age of > or = 65 yr (RR = 2.2; 95% confidence interval (CI) = 1.1-4.4; P = 0.03), MELD score of > or = 25 (RR = 3.2; 95% CI = 1.8-5.5; P < 0.0001), and abnormal MPI (RR = 2.4; 95% CI = 1.1-5.2; P = 0.02). The 2-yr mortality was 24% for patients with normal MPI and 45% for those with inducible MPI abnormalities (P = 0.003). In conclusion, MPI obtained by RTMCE appears to be a useful tool in predicting mortality in patients with ALD. Further studies are required to verify its independent value.
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Affiliation(s)
- Jeane M Tsutsui
- Department of Internal Medicine, Section of Cardiology, University of Nebraska Medical Center, Omaha, NE 68198-1165, USA
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Dijkmans PA, Knaapen P, Sieswerda GTJ, Aiazian E, Visser CA, Lammertsma AA, Visser FC, Kamp O. Quantification of Myocardial Perfusion Using Intravenous Myocardial Contrast Echocardiography in Healthy Volunteers: Comparison with Positron Emission Tomography. J Am Soc Echocardiogr 2006; 19:285-93. [PMID: 16500491 DOI: 10.1016/j.echo.2005.10.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Intravenous myocardial contrast echocardiography (ivMCE) has the potential to evaluate myocardial contraction and perfusion simultaneously. The purpose of this study was to assess quantification of myocardial blood flow (MBF) using ivMCE and to compare this with MBF as measured with positron emission tomography (PET). METHODS A total of 16 healthy volunteers underwent ivMCE using power pulse inversion and contrast agent microbubbles at rest and during pharmacologically induced vasodilation. Microbubble destruction was achieved with a burst of high-energy ultrasound, followed by imaging of contrast replenishment with low-energy ultrasound. Regions of interest were drawn and time intensity curves were calculated that were fitted to a monoexponential function. An estimate of MBF (perfusion estime) was calculated as the product of the plateau value A and the exponential beta describing the replenishment curve. MBF was measured with PET using oxygen-15-labeled water at rest and during adenosine stress. RESULTS Significant correlations were found between MBF as measured with PET and perfusion estimate as measured with ivMCE in the left anterior descending coronary artery (r = 0.87, P < .01), right coronary artery (r = 0.66, P < .01), and left circumflex artery (r = 0.75, P < .01) territories. Heterogeneity, however, was significantly larger for ivMCE (coefficient of variation 32 +/- 15%) than for PET (9 +/- 6%) measurements (P < .01). CONCLUSION Perfusion parameters as measured with ivMCE correlated with PET-derived MBF, but associated heterogeneity was significantly larger. Currently, this heterogeneity precludes true quantification of MBF using ivMCE.
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Affiliation(s)
- Pieter A Dijkmans
- Department of Cardiology, Institute of Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands.
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45
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Dourado PMM, Tsutsui JM, Chagas ACP, Sbano JCN, Aiello VD, da Luz PL, Mathias Jr W, Ramires JAF. Value of adenosine infusion for infarct size determination using real-time myocardial contrast echocardiography. Cardiovasc Ultrasound 2006; 4:10. [PMID: 16466579 PMCID: PMC1386705 DOI: 10.1186/1476-7120-4-10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2005] [Accepted: 02/08/2006] [Indexed: 12/04/2022] Open
Abstract
Background Myocardial contrast echocardiography has been used for determination of infarct size (IS) in experimental models. However, with intermittent harmonic imaging, IS seems to be underestimated immediately after reperfusion due to areas with preserved, yet dysfunctional, microvasculature. The use of exogenous vasodilators showed to be useful to unmask these infarcted areas with depressed coronary flow reserve. This study was undertaken to assess the value of adenosine for IS determination in an open-chest canine model of coronary occlusion and reperfusion, using real-time myocardial contrast echocardiography (RTMCE). Methods Nine dogs underwent 180 minutes of coronary occlusion followed by reperfusion. PESDA (Perfluorocarbon-Exposed Sonicated Dextrose Albumin) was used as contrast agent. IS was determined by RTMCE before and during adenosine infusion at a rate of 140 mcg·Kg-1·min-1. Post-mortem necrotic area was determined by triphenyl-tetrazolium chloride (TTC) staining. Results IS determined by RTMCE was 1.98 ± 1.30 cm2 and increased to 2.58 ± 1.53 cm2 during adenosine infusion (p = 0.004), with good correlation between measurements (r = 0.91; p < 0.01). The necrotic area determined by TTC was 2.29 ± 1.36 cm2 and showed no significant difference with IS determined by RTMCE before or during hyperemia. A slight better correlation between RTMCE and TTC measurements was observed during adenosine (r = 0.99; p < 0.001) then before it (r = 0.92; p = 0.0013). Conclusion RTMCE can accurately determine IS in immediate period after acute myocardial infarction. Adenosine infusion results in a slight better detection of actual size of myocardial damage.
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Affiliation(s)
| | - Jeane Mike Tsutsui
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | | | | | - Vera demarchi Aiello
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | | | - Wilson Mathias Jr
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Jose AF Ramires
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
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da Trindade MLZH, Tsutsui JM, Rodrigues ACT, Caldas MA, Ramires JAF, Mathias W. Left ventricular free wall impeding rupture in post-myocardial infarction period diagnosed by myocardial contrast echocardiography: case report. Cardiovasc Ultrasound 2006; 4:7. [PMID: 16438720 PMCID: PMC1395330 DOI: 10.1186/1476-7120-4-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2006] [Accepted: 01/26/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Left ventricular free wall rupture occurs in up to 10% of the in-hospital deaths following myocardial infarction. It is mainly associated with posterolateral myocardial infarction and its antemortem diagnosis is rarely made. Contrast echocardiography has been increasingly used for the evaluation of myocardial perfusion in patients with acute myocardial infarction, with important prognostic implications. In this case, we reported its use for the detection of a mechanical complication following myocardial infarction. CASE PRESENTATION A 50-year-old man with acute myocardial infarction in the lateral wall underwent myocardial contrast echocardiography for the evaluation of myocardial perfusion in the third day post-infarction. A perfusion defect was detected in lateral and inferior walls as well as the presence of contrast extrusion from the left ventricular cavity into the myocardium, forming a serpiginous duct extending from the endocardium to the epicardial region of the lateral wall, without communication with the pericardial space. Magnetic resonance imaging confirmed the diagnosis of impending rupture of the left ventricular free wall. While waiting for cardiac surgery, patient presented with cardiogenic shock and died. Anatomopathological findings were consistent with acute myocardial infarction in the lateral wall and a left ventricular free wall rupture at the infarct site. CONCLUSION This case illustrates the early diagnosis of left ventricular free wall rupture by contrast echocardiography. Due to its ability to be performed at bedside this modality of imaging has the potential to identify this catastrophic condition in patients with acute myocardial infarction and help to treat these patients with emergent surgery.
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Affiliation(s)
| | - Jeane Mike Tsutsui
- Heart Institute (InCor) – University of São Paulo Medical School, São Paulo, Brazil
| | | | | | | | - Wilson Mathias
- Heart Institute (InCor) – University of São Paulo Medical School, São Paulo, Brazil
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47
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Elhendy A, Porter TR. Assessment of myocardial perfusion with real-time myocardial contrast echocardiography: methodology and clinical applications. J Nucl Cardiol 2006; 12:582-90. [PMID: 16171719 DOI: 10.1016/j.nuclcard.2005.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Real-time myocardial contrast perfusion imaging (RTMCI) with echocardiography is a promising technique for evaluation of patients with known or suspected coronary artery disease. The technique is based on the utilization of small (<10 mum) microbubbles, which are capable of crossing the pulmonary circulation after intravenous injection. Unlike radioactive isotopes, which are taken actively or diffuse passively in the myocytes, myocardial contrast agents remain extracellularly in the capillaries and present a measure of the myocardial capillary blood volume and microvascular integrity. RTMCI has been shown to be a safe and feasible method for the assessment of myocardial perfusion at rest and with pharmacologic stress. Recent studies have shown the value of RTMCI with dobutamine stress in improving overall and regional detection of coronary artery disease and detecting of abnormalities at submaximal stress, therefore improving sensitivity in patients who are unable to achieve the target heart rate. The advantages of the technique include the ability to assess perfusion at bedside in one setting, simultaneous assessment of myocardial function, shorter imaging time, no need for ionizing irradiation, immediate availability of the results, and the ability to determine the ischemic threshold. Recent studies have shown that RTMCI improves the prognostic utility of standard dobutamine stress in addition to wall motion analysis. Patients with normal perfusion had a better outcome than those with normal wall motion. The combination of abnormal wall motion and perfusion identified patients at greatest risk of death and nonfatal myocardial infarction. Perfusion abnormalities were also shown to predict short-term cardiac events in patients presenting to the emergency department with chest pain and no ST-segment elevation. Refinement of imaging techniques is expected to improve the specificity of RTMCI, particularly in differentiating true perfusion defects from artifacts. This review will discuss the physiologic basis, methodology, clinical utility, and limitations of RTMCI in the assessment of patients with known or suspected coronary artery disease.
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Affiliation(s)
- Abdou Elhendy
- Department of Internal Medicine, Section of Cardiology, University of Nebraska Medical Center, 982265 Nebraska Medical Center, Omaha, NE 68198-2265, USA.
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Korosoglou G, Dubart AE, DaSilva KGC, Labadze N, Hardt S, Hansen A, Bekeredjian R, Zugck C, Zehelein J, Katus HA, Kuecherer H. Real-time myocardial perfusion imaging for pharmacologic stress testing: added value to single photon emission computed tomography. Am Heart J 2006; 151:131-8. [PMID: 16368304 DOI: 10.1016/j.ahj.2005.02.046] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2004] [Accepted: 02/23/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Little is known about the incremental value of real-time myocardial contrast echocardiography (MCE) as an adjunct to pharmacologic stress testing. This study was performed to evaluate the diagnostic value of MCE to detect abnormal myocardial perfusion by technetium Tc 99m sestamibi-single photon emission computed tomography (SPECT) and anatomically significant coronary artery disease (CAD) by angiography. METHODS Myocardial contrast echocardiography was performed at rest and during vasodilator stress in consecutive patients (N = 120) undergoing SPECT imaging for known or suspected CAD. Myocardial opacification, wall motion, and tracer uptake were visually analyzed in 12 myocardial segments by 2 pairs of blinded observers. Concordance between the 2 methods was assessed using the kappa statistic. RESULTS Of 1356 segments, 1025 (76%) were interpretable by MCE, wall motion, and SPECT. Sensitivity of wall motion was 75%, specificity 83%, and accuracy 81% for detecting abnormal myocardial perfusion by SPECT (kappa = 0.53). Myocardial contrast echocardiography and wall motion together yielded significantly higher sensitivity (85% vs 74%, P < .05), specificity of 83%, and accuracy of 85% (kappa = 0.64) for the detection of abnormal myocardial perfusion. In 89 patients who underwent coronary angiography, MCE and wall motion together yielded higher sensitivity (83% vs 64%, P < .05) and accuracy (77% vs 68%, P < .05) but similar specificity (72%) compared with SPECT for the detection of high-grade, stenotic (> or = 75%) coronary lesions. CONCLUSION Assessment of myocardial perfusion adds value to conventional stress echocardiography by increasing its sensitivity for the detection of functionally abnormal myocardial perfusion. Myocardial contrast echocardiography and wall motion together provide higher sensitivity and accuracy for detection of CAD compared with SPECT.
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49
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Chung N. Assessment of Myocardial Perfusion With Intravenous Myocardial Contrast Echocardiography Current State and Clinical Applications. J Echocardiogr 2006. [DOI: 10.2303/jecho.4.91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Tsutsui JM, Kusler M, Porter TR. Intravenous myocardial contrast echocardiography for the diagnosis of coronary artery disease. Curr Opin Cardiol 2005; 20:381-5. [PMID: 16093756 DOI: 10.1097/01.hco.0000176404.48496.a2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Myocardial contrast echocardiography is a recently developed technique that permits the noninvasive assessment of myocardial perfusion. Myocardial contrast enhancement from microbubbles characteristically reflects the myocardial blood volume. The analysis of microbubble kinetics using quantitative myocardial contrast echocardiography permits the evaluation of myocardial blood flow both at rest and during pharmacological stress. RECENT FINDINGS Myocardial contrast echocardiography has been shown to have good concordance with single photon emission computed tomography for the localization of perfusion abnormalities. As a result of its better spatial resolution and the fact that it tracks myocardial blood flow changes, it seems to have higher sensitivity for the detection of angiographically significant coronary artery disease, while maintaining similar specificity to single photon emission computed tomography. Low mechanical index imaging techniques (real-time myocardial contrast echocardiography) have the advantage of permitting simultaneous analysis of wall motion and perfusion, which is particularly important during dobutamine stress. Myocardial perfusion analysis using real-time myocardial contrast echocardiography has been shown to have higher sensitivity and diagnostic accuracy than wall motion analysis for the detection of coronary artery disease. Quantitative myocardial contrast echocardiography seems to overcome the expertise requirements for appropriate interpretation of myocardial perfusion images, and may have been demonstrated to be an accurate supplemental technique for estimating the severity of coronary artery disease. SUMMARY Recent technological advances have positioned myocardial contrast echocardiography as a safe and feasible technique for the evaluation of myocardial perfusion. The analysis of myocardial perfusion using myocardial contrast echocardiography has higher diagnostic accuracy than wall motion analysis for detecting coronary artery disease.
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Affiliation(s)
- Jeane M Tsutsui
- Department of Internal Medicine, Section of Cardiology, University of Nebraska Medical Center, Omaha, Nebraska 68198-1165, USA
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