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Zhang J, Li X, Liu J, Shang Y, Tan L, Guo Y. Early and dynamic detection of doxorubicin induced cardiotoxicity by myocardial contrast echocardiography combined with two-dimensional speckle tracking echocardiography in rats. Front Cardiovasc Med 2023; 9:1063499. [PMID: 36712239 PMCID: PMC9880177 DOI: 10.3389/fcvm.2022.1063499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 12/27/2022] [Indexed: 01/15/2023] Open
Abstract
Background Anthracycline-induced cardiotoxicity is well-known as a side effect of chemotherapy. Currently, clinical imaging techniques are not capable to detect doxorubicin (DOX)-induced cardiotoxicity before a functional decline. The purpose of this study was to evaluate whether myocardial contrast echocardiography (MCE) can dynamically monitor the cardiac changes in the early stage in the DOX-induced rat model of cardiotoxicity. Methods A weekly injection of 2.5 mg/kg of DOX was used to generate a rat model of cardiotoxicity. All groups underwent ultrasonic examinations including standard echocardiography, 2D speckle tracking echocardiography (2D-STE), and MCE. Then all rats were sacrificed immediately for histopathological evaluation. Results A total of eight control rats and 32 DOX-treated rats were included in the study and grouped according to their treatment period. Decreased quantitative parameters of myocardial blood flow (MBF) (control vs. group 1: 133.31 ± 20.23 dB/s vs. 103.35 ± 21.60 dB/s, P = 0.048) and β (control vs. group 2: 11.17 ± 1.48/s vs. 7.15 ± 1.23/s, P < 0.001) were observed after 2 and 4 weeks of treatment, respectively, while left ventricular global strain (control vs. group 3: -23.67 ± 3.92% vs. -16.01 ± 3.40%, P = 0.002) decreased after 6 weeks of treatment and left ventricular ejection fraction (LVEF) (control vs. group 4: 82.41 ± 3.20% vs. 70.89 ± 9.30%, P = 0.008) decreased after 8 weeks of treatment. The main histopathological features are increased myocardial vacuolization and interstitial fibrosis and decreased myocardial microvessel density. Conclusion Compared with standard echocardiography and 2D-STE, MCE can accurately and non-invasively detect changes in early myocardial perfusion, demonstrating the clinical potential of continuous and dynamic monitoring of DOX-induced cardiotoxicity.
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Cotter B, Raisinghani A, DeMaria AN. Established and emerging roles for ultrasound enhancing agents (contrast echocardiography). Clin Cardiol 2022; 45:1114-1122. [PMID: 36183366 DOI: 10.1002/clc.23924] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 08/22/2022] [Indexed: 11/10/2022] Open
Abstract
The ability to opacify the left ventricle and delineate the endocardium after intravenous injection of microbubble ultrasound enhancing agents is of established value to quantify volumes and function in suboptimal unenhanced images, particularly in stress echocardiograms. However, applications other than quantitation of left ventricle structure and function exist for contrast enhanced left ventricular opacification. Contrast agents enable recording of Doppler velocity signals in patients with poor ultrasound transmission, providing estimates of aortic stenosis gradient and pulmonary artery pressures. Contrast echo is of value in detecting apical hypertrophic cardiomyopathy and accompanying apical aneurysms. Most importantly, ultrasound enhancing agents can identify apical and left atrial masses when they cannot be visualized in unenhanced images, and can distinguish thrombi from tumors by visualizing the vascularity inherent in tumors. Contrast agents distinguish trabecular from compacted myocardium in noncompaction syndrome, and hypertrabeculation with other abnormal conditions. A major potential application of ultrasound enhancing agents is myocardial opacification, which can assist in identifying nonviable myocardium. Also, the delayed reappearance of myocardial perfusion after microbubble destruction identifies impaired contrary flow and can diagnose coronary stenosis. Innovative applications of ultrasound contrast agents currently under investigation, include visualizing the vaso vasorum to identify plaques and assess their vulnerability, and theranostic agents to deliver drugs and biologists and to assist in sonothrombolysis. It is anticipated that the role of ultrasound contrast agents will continue to increase in the future.
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Affiliation(s)
- Bruno Cotter
- Division of Cardiology, Department of Medicine, Sulpizio Cardiovascular Center, University of California San Diego, San Diego, California, USA
| | - Ajit Raisinghani
- Division of Cardiology, Department of Medicine, Sulpizio Cardiovascular Center, University of California San Diego, San Diego, California, USA
| | - Anthony N DeMaria
- Division of Cardiology, Department of Medicine, Sulpizio Cardiovascular Center, University of California San Diego, San Diego, California, USA
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Reid A, Dweck MR. Let there be light! The meteoric rise of cardiac imaging. BRITISH HEART JOURNAL 2022; 108:780-786. [PMID: 35459728 DOI: 10.1136/heartjnl-2021-320147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/02/2022] [Indexed: 11/04/2022]
Abstract
Imaging plays a central role in modern cardiovascular practice. It is a field characterised by exciting technological advances that have shaped our understanding of pathology and led to major improvements in patient diagnosis and care. The UK has played a key international role in the development of this subspecialty and is the current home to many of the leading global centres in multimodality cardiovascular imaging. In this short review, we will outline some of the key contributions of the British Cardiovascular Society and its members to this rapidly evolving field and look at how this relationship may continue to shape future cardiovascular practice.
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Affiliation(s)
- Anna Reid
- Department of Cardiology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Marc Richard Dweck
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
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Cimorelli M, Flynn MA, Angel B, Reimold E, Banka SS, Andrien B, Fafarman A, Huneke R, Kohut A, Wrenn S. Selective Enhancement of Swine Myocardium with a Novel Ultrasound Enhancing Agent During Transthoracic Echocardiography. J Cardiovasc Transl Res 2022; 15:722-729. [PMID: 35099715 DOI: 10.1007/s12265-022-10207-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 01/20/2022] [Indexed: 11/30/2022]
Abstract
Ultrasound enhancing agents are approved to delineate the endocardial border and opacify the left ventricle cavity (LVC). We present a nested phase change agent (NPCA) designed to enable selective myocardial enhancement without enhancing the LVC by employing a dual-activation mechanism dependent on sufficient ultrasound intensity and the microenvironment of the myocardium. Swine received bolus injections of NPCA while echocardiograms were collected and processed to determine background-subtracted acoustic intensities (AI) in the LVC and septal myocardium. At mechanical index (MI) ≥ 0.8, the NPCA enhanced the myocardium selectively (p < 0.001) while the LVC remained at baseline AI. A 5-mL bolus of NPCA enhanced swine myocardium and enhancement persisted for > 5 min at 1.4 MI, while hemodynamics and EKG remained normal. Our findings demonstrate that the NPCA enhances swine myocardium selectively without enhancing the LVC. The NPCA could have utility for functional and structural echocardiographic studies with clinical ultrasound using standard settings.
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Affiliation(s)
- Michael Cimorelli
- Chemical and Biological Engineering, Drexel University, Philadelphia, PA, USA.
| | - Michael A Flynn
- Chemical and Biological Engineering, Drexel University, Philadelphia, PA, USA
| | - Brett Angel
- Cardiology, Drexel University College of Medicine, Philadelphia, PA, USA.,Cardiology, Tower Health, Phoenixville, PA, USA
| | - Emily Reimold
- University Laboratory Animal Resources, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Sahil S Banka
- Cardiology, Einstein Medical Center, Philadelphia, PA, USA
| | - Benjamin Andrien
- Chemical and Biological Engineering, Drexel University, Philadelphia, PA, USA
| | - Aaron Fafarman
- Chemical and Biological Engineering, Drexel University, Philadelphia, PA, USA
| | - Richard Huneke
- University Laboratory Animal Resources, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Andrew Kohut
- Cardiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Steven Wrenn
- Chemical and Biological Engineering, Drexel University, Philadelphia, PA, USA. .,Chemical Engineering, Virginia Tech, Blacksburg, VA, USA.
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Almeida AG, Carpenter JP, Cameli M, Donal E, Dweck MR, Flachskampf FA, Maceira AM, Muraru D, Neglia D, Pasquet A, Plein S, Gerber BL. Multimodality imaging of myocardial viability: an expert consensus document from the European Association of Cardiovascular Imaging (EACVI). Eur Heart J Cardiovasc Imaging 2021; 22:e97-e125. [PMID: 34097006 DOI: 10.1093/ehjci/jeab053] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Indexed: 12/17/2022] Open
Abstract
In clinical decision making, myocardial viability is defined as myocardium in acute or chronic coronary artery disease and other conditions with contractile dysfunction but maintained metabolic and electrical function, having the potential to improve dysfunction upon revascularization or other therapy. Several pathophysiological conditions may coexist to explain this phenomenon. Cardiac imaging may allow identification of myocardial viability through different principles, with the purpose of prediction of therapeutic response and selection for treatment. This expert consensus document reviews current insight into the underlying pathophysiology and available methods for assessing viability. In particular the document reviews contemporary viability imaging techniques, including stress echocardiography, single photon emission computed tomography, positron emission tomography, cardiovascular magnetic resonance, and computed tomography and provides clinical recommendations for how to standardize these methods in terms of acquisition and interpretation. Finally, it presents clinical scenarios where viability assessment is clinically useful.
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Affiliation(s)
- Ana G Almeida
- Faculty of Medicine, Lisbon University, University Hospital Santa Maria/CHLN, Portugal
| | - John-Paul Carpenter
- Cardiology Department, University Hospitals Dorset, NHS Foundation Trust, Poole Hospital, Longfleet Road, Poole, Dorset BH15 2JB, United Kingdom
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci 16, Siena, Italy
| | - Erwan Donal
- Department of Cardiology, CHU Rennes, Inserm, LTSI-UMR 1099, Université de Rennes 1, Rennes F-35000, France
| | - Marc R Dweck
- BHF Centre for Cardiovascular Science, The University of Edinburgh & Edinburgh Heart Centre, Chancellors Building Little France Crescent, Edinburgh EH16 4SB, United Kingdom
| | - Frank A Flachskampf
- Dept. of Med. Sciences, Uppsala University, and Cardiology and Clinical Physiology, Uppsala University Hospital, Akademiska, 751 85 Uppsala, Sweden
| | - Alicia M Maceira
- Cardiovascular Imaging Unit, Ascires Biomedical Group Colon St, 1, Valencia 46004, Spain; Department of Medicine, Health Sciences School, CEU Cardenal Herrera University, Lluís Vives St. 1, 46115 Alfara del Patriarca, Valencia, Spain
| | - Denisa Muraru
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy; Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, Piazzale Brescia 20, 20149, Milan, Italy
| | - Danilo Neglia
- Fondazione Toscana G. Monasterio-Via G. Moruzzi 1, Pisa, Italy
| | - Agnès Pasquet
- Service de Cardiologie, Département Cardiovasculaire, Cliniques Universitaires St. Luc, and Division CARD, Institut de Recherche Expérimental et Clinique (IREC), UCLouvain, Av Hippocrate 10, B-1200 Brussels, Belgium
| | - Sven Plein
- Department of Biomedical Imaging Science, Leeds, Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds LS2 9JT, United Kingdom
| | - Bernhard L Gerber
- Department of Biomedical Imaging Science, Leeds, Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds LS2 9JT, United Kingdom
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Abstract
Gas-filled microbubbles are currently in clinical use as blood pool contrast agents for ultrasound imaging. The goal of this review is to discuss the trends and issues related to these relatively unusual intravascular materials, which are not small molecules per se, not polymers, not even nanoparticles, but larger micrometer size structures, compressible, flexible, elastic, and deformable. The intent is to connect current research and initial studies from 2 to 3 decades ago, tied to gas exchange between the bubbles and surrounding biological medium, in the following areas of focus: (1) parameters of microbubble movement in relation to vasculature specifics; (2) gas uptake and loss from the bubbles in the vasculature; (3) adhesion of microbubbles to target receptors in the vasculature; and (4) microbubble interaction with the surrounding vessels and tissues during insonation.Microbubbles are generally safe and require orders of magnitude lower material doses than x-ray and magnetic resonance imaging contrast agents. Application of microbubbles will soon extend beyond blood pool contrast and tissue perfusion imaging. Microbubbles can probe molecular and cellular biomarkers of disease by targeted contrast ultrasound imaging. This approach is now in clinical trials, for example, with the aim to detect and delineate tumor nodes in prostate, breast, and ovarian cancer. Imaging of inflammation, ischemia-reperfusion injury, and ischemic memory is also feasible. More importantly, intravascular microbubbles can be used for local deposition of focused ultrasound energy to enhance drug and gene delivery to cells and tissues, across endothelial barrier, especially blood-brain barrier.Overall, microbubble behavior, stability and in vivo lifetime, bioeffects upon the action of ultrasound and resulting enhancement of drug and gene delivery, as well as targeted imaging are critically dependent on the events of gas exchange between the bubbles and surrounding media, as outlined in this review.
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Affiliation(s)
- Alexander L Klibanov
- From the Cardiovascular Division, Department of Medicine and Robert M. Berne Cardiovascular Research Center, University of Virginia School of Medicine; and Departments of Biomedical Engineering, and Radiology, University of Virginia, Charlottesville, VA
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Wang S, Hossack JA, Klibanov AL. From Anatomy to Functional and Molecular Biomarker Imaging and Therapy: Ultrasound Is Safe, Ultrafast, Portable, and Inexpensive. Invest Radiol 2020; 55:559-572. [PMID: 32776766 PMCID: PMC10290890 DOI: 10.1097/rli.0000000000000675] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Ultrasound is the most widely used medical imaging modality worldwide. It is abundant, extremely safe, portable, and inexpensive. In this review, we consider some of the current development trends for ultrasound imaging, which build upon its current strength and the popularity it experiences among medical imaging professional users.Ultrasound has rapidly expanded beyond traditional radiology departments and cardiology practices. Computing power and data processing capabilities of commonly available electronics put ultrasound systems in a lab coat pocket or on a user's mobile phone. Taking advantage of new contributions and discoveries in ultrasound physics, signal processing algorithms, and electronics, the performance of ultrasound systems and transducers have progressed in terms of them becoming smaller, with higher imaging performance, and having lower cost. Ultrasound operates in real time, now at ultrafast speeds; kilohertz frame rates are already achieved by many systems.Ultrasound has progressed beyond anatomical imaging and monitoring blood flow in large vessels. With clinical approval of ultrasound contrast agents (gas-filled microbubbles) that are administered in the bloodstream, tissue perfusion studies are now routine. Through the use of modern ultrasound pulse sequences, individual microbubbles, with subpicogram mass, can be detected and observed in real time, many centimeters deep in the body. Ultrasound imaging has broken the wavelength barrier; by tracking positions of microbubbles within the vasculature, superresolution imaging has been made possible. Ultrasound can now trace the smallest vessels and capillaries, and obtain blood velocity data in those vessels.Molecular ultrasound imaging has now moved closer to clinic; the use of microbubbles with a specific affinity to endothelial biomarkers allows selective accumulation and retention of ultrasound contrast in the areas of ischemic injury, inflammation, or neoangiogenesis. This will aid in noninvasive molecular imaging and may provide additional help with real-time guidance of biopsy, surgery, and ablation procedures.The ultrasound field can be tightly focused inside the body, many centimeters deep, with millimeter precision, and ablate lesions by energy deposition, with thermal or mechanical bioeffects. Some of such treatments are already in clinical use, with more indications progressing through the clinical trial stage. In conjunction with intravascular microbubbles, focused ultrasound can be used for tissue-specific drug delivery; localized triggered release of sequestered drugs from particles in the bloodstream may take time to get to clinic. A combination of intravascular microbubbles with circulating drug and low-power ultrasound allows transient opening of vascular endothelial barriers, including blood-brain barrier; this approach has reached clinical trial stage. Therefore, the drugs that normally would not be getting to the target tissue in the brain will now have an opportunity to produce therapeutic efficacy.Overall, medical ultrasound is developing at a brisk rate, even in an environment where other imaging modalities are also advancing rapidly and may be considered more lucrative. With all the current advances that we discuss, and many more to come, ultrasound may help solve many problems that modern medicine is facing.
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8
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Klibanov AL. Ultrasound Molecular Imaging of Cancer: Design and Formulation Strategies of Targeted Contrast Agents. Recent Results Cancer Res 2020; 216:319-336. [PMID: 32594391 DOI: 10.1007/978-3-030-42618-7_9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Gas-filled particles (microbubbles) can be prepared and stabilized for intravascular use as contrast agents in ultrasound imaging. Microbubbles are used in clinics as blood pool contrast materials for the past two decades. Shell of these bubbles is made of biocompatible and biodegradable lipids, proteins, and/or polymers. Gas core is air, or, lately, a perfluorinated gas, poorly soluble in water and blood. Making them useful for molecular targeting and molecular imaging in oncology is accomplished by decorating the shell of these particles with targeting ligands, that will selectively bind to the specific markers of tumor vasculature. In this review we discuss the formulation strategy for microbubble preparation, the logic of bubble shell selection, coupling tools that are used for the attachment of targeting ligands, and examples of the application of gas-filled bubbles for molecular imaging in oncology.
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Affiliation(s)
- Alexander L Klibanov
- Cardiovascular Division (Department of Medicine), Robert M Berne Cardiovascular Research Center, University of Virginia, Charlottesville, VA, 22908, USA.
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9
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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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10
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Long-Term Association of Dipyridamole Stress Myocardial Contrast Echocardiography versus Single-Photon Emission Computed Tomography with Clinical Outcomes in Patients with Known or Suspected Coronary Artery Disease. J Am Soc Echocardiogr 2018; 31:860-869. [DOI: 10.1016/j.echo.2018.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Indexed: 11/20/2022]
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11
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Senior R, Becher H, Monaghan M, Agati L, Zamorano J, Vanoverschelde JL, Nihoyannopoulos P, Edvardsen T, Lancellotti P. Clinical practice of contrast echocardiography: recommendation by the European Association of Cardiovascular Imaging (EACVI) 2017. Eur Heart J Cardiovasc Imaging 2018; 18:1205-1205af. [PMID: 28950366 DOI: 10.1093/ehjci/jex182] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 06/20/2017] [Indexed: 12/16/2022] Open
Abstract
Contrast echocardiography is widely used in cardiology. It is applied to improve image quality, reader confidence and reproducibility both for assessing left ventricular (LV) structure and function at rest and for assessing global and regional function in stress echocardiography. The use of contrast in echocardiography has now extended beyond cardiac structure and function assessment to evaluation of perfusion both of the myocardium and of the intracardiac structures. Safety of contrast agents have now been addressed in large patient population and these studies clearly established its excellent safety profile. This document, based on clinical trials, randomized and multicentre studies and published clinical experience, has established clear recommendations for the use of contrast in various clinical conditions with evidence-based protocols.
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Affiliation(s)
- Roxy Senior
- Department of Cardiology, Royal Brompton Hospital, Imperial College, Sydney Street, London SW3 6NP, UK
| | | | | | | | - Jose Zamorano
- CIBERCV, University Hospital Ramón y Cajal, Madrid, Spain
| | | | | | | | - Patrizio Lancellotti
- University of Liege Hospital, GIGA Cardiovascular Science, Heart Valve Clinic, Imaging Cardiology, Liege, Belgium
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Porter TR, Mulvagh SL, Abdelmoneim SS, Becher H, Belcik JT, Bierig M, Choy J, Gaibazzi N, Gillam LD, Janardhanan R, Kutty S, Leong-Poi H, Lindner JR, Main ML, Mathias W, Park MM, Senior R, Villanueva F. Clinical Applications of Ultrasonic Enhancing Agents in Echocardiography: 2018 American Society of Echocardiography Guidelines Update. J Am Soc Echocardiogr 2018; 31:241-274. [DOI: 10.1016/j.echo.2017.11.013] [Citation(s) in RCA: 142] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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13
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Wang S, Hossack JA, Klibanov AL. Targeting of microbubbles: contrast agents for ultrasound molecular imaging. J Drug Target 2018; 26:420-434. [PMID: 29258335 DOI: 10.1080/1061186x.2017.1419362] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
For contrast ultrasound imaging, the most efficient contrast agents comprise highly compressible gas-filled microbubbles. These micrometer-sized particles are typically filled with low-solubility perfluorocarbon gases, and coated with a thin shell, often a lipid monolayer. These particles circulate in the bloodstream for several minutes; they demonstrate good safety and are already in widespread clinical use as blood pool agents with very low dosage necessary (sub-mg per injection). As ultrasound is an ubiquitous medical imaging modality, with tens of millions of exams conducted annually, its use for molecular/targeted imaging of biomarkers of disease may enable wider implementation of personalised medicine applications, precision medicine, non-invasive quantification of biomarkers, targeted guidance of biopsy and therapy in real time. To achieve this capability, microbubbles are decorated with targeting ligands, possessing specific affinity towards vascular biomarkers of disease, such as tumour neovasculature or areas of inflammation, ischaemia-reperfusion injury or ischaemic memory. Once bound to the target, microbubbles can be selectively visualised to delineate disease location by ultrasound imaging. This review discusses the general design trends and approaches for such molecular ultrasound imaging agents, which are currently at the advanced stages of development, and are evolving towards widespread clinical trials.
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Affiliation(s)
- Shiying Wang
- a Department of Biomedical Engineering , University of Virginia , Charlottesville , VA , USA
| | - John A Hossack
- a Department of Biomedical Engineering , University of Virginia , Charlottesville , VA , USA
| | - Alexander L Klibanov
- a Department of Biomedical Engineering , University of Virginia , Charlottesville , VA , USA.,b Cardiovascular Division (Department of Medicine), Robert M Berne Cardiovascular Research Center , University of Virginia , Charlottesville , VA , USA
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14
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Rojas JD, Lin F, Chiang YC, Chytil A, Chong DC, Bautch VL, Rathmell WK, Dayton PA. Ultrasound Molecular Imaging of VEGFR-2 in Clear-Cell Renal Cell Carcinoma Tracks Disease Response to Antiangiogenic and Notch-Inhibition Therapy. Theranostics 2018; 8:141-155. [PMID: 29290798 PMCID: PMC5743465 DOI: 10.7150/thno.19658] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 09/14/2017] [Indexed: 12/22/2022] Open
Abstract
Metastatic clear-cell renal cell carcinoma (ccRCC) affects thousands of patients worldwide each year. Antiangiogenic therapy has been shown to have beneficial effects initially, but resistance is eventually developed. Therefore, it is important to accurately track the response of cancer to different therapeutics in order to appropriately adjust the therapy to maximize efficacy. Change in tumor volume is the current gold standard for determining efficacy of treatment. However, functional variations can occur much earlier than measurable volume changes. Contrast-enhanced ultrasound (CEUS) is an important tool for assessing tumor progression and response to therapy, since it can monitor functional changes in the physiology. In this study, we demonstrate how ultrasound molecular imaging (USMI) can accurately track the evolution of the disease and molecular response to treatment. Methods A cohort of NSG (NOD/scid/gamma) mice was injected with ccRCC cells and treated with either the VEGF inhibitor SU (Sunitinib malate, Selleckchem, TX, USA) or the Notch pathway inhibitor GSI (Gamma secretase inhibitor, PF-03084014, Pfizer, New York, NY, USA), or started on SU and later switched to GSI (Switch group). The therapies used in the study focus on disrupting angiogenesis and proper vessel development. SU inhibits signaling of vascular endothelial growth factor (VEGF), which is responsible for the sprouting of new vasculature, and GSI inhibits the Notch pathway, which is a key factor in the correct maturation of newly formed vasculature. Microbubble contrast agents targeted to VEGFR-2 (VEGF Receptor) were delivered as a bolus, and the bound agents were imaged in 3D after the free-flowing contrast was cleared from the body. Additionally, the tumors were harvested at the end of the study and stained for CD31. Results The results show that MI can detect changes in VEGFR-2 expression in the group treated with SU within a week of the start of treatment, while differences in volume only become apparent after the mice have been treated for three weeks. Furthermore, USMI can detect response to therapy in 92% of cases after 1 week of treatment, while the detection rate is only 40% for volume measurements. The amount of targeting for the GSI and Control groups was high throughout the duration of the study, while that of the SU and Switch groups remained low. However, the amount of targeting in the Switch group increased to levels similar to those of the Control group after the treatment was switched to GSI. CD31 staining indicates significantly lower levels of patent vasculature for the SU group compared to the Control and GSI groups. Therefore, the results parallel the expected physiological changes in the tumor, since GSI promotes angiogenesis through the VEGF pathway, while SU inhibits it. Conclusion This study demonstrates that MI can track disease progression and assess functional changes in tumors before changes in volume are apparent, and thus, CEUS can be a valuable tool for assessing response to therapy in disease. Future work is required to determine whether levels of VEGFR-2 targeting correlate with eventual survival outcomes.
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Affiliation(s)
- Juan D Rojas
- Joint Department of Biomedical Engineering, The University of North Carolina and North Carolina State University, Chapel Hill, North Carolina
| | - Fanglue Lin
- Joint Department of Biomedical Engineering, The University of North Carolina and North Carolina State University, Chapel Hill, North Carolina
| | - Yun-Chen Chiang
- Lineberger Comprehensive Cancer Center, The University of North Carolina, Chapel Hill, North Carolina
| | - Anna Chytil
- Department of Medicine, Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Diana C Chong
- Curriculum in Genetics and Molecular Biology, The University of North Carolina, Chapel Hill, North Carolina
| | - Victoria L Bautch
- Lineberger Comprehensive Cancer Center, The University of North Carolina, Chapel Hill, North Carolina
- Curriculum in Genetics and Molecular Biology, The University of North Carolina, Chapel Hill, North Carolina
- Department of Biology, The University of North Carolina, Chapel Hill, North Carolina
| | - W Kimryn Rathmell
- Department of Medicine, Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Paul A Dayton
- Joint Department of Biomedical Engineering, The University of North Carolina and North Carolina State University, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, The University of North Carolina, Chapel Hill, North Carolina
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15
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Alvarez E, Dalton ND, Gu Y, Smith D, Luong A, Hoshijima M, Peterson KL, Rychak J. A novel method for quantitative myocardial contrast echocardiography in mice. Am J Physiol Heart Circ Physiol 2017; 314:H370-H379. [PMID: 29127239 DOI: 10.1152/ajpheart.00568.2017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The small size of the mouse heart frequently imparts technical challenges when applying conventional in vivo imaging methods for assessing heart function. Here, we describe the use of high-frequency ultrasound imaging in conjunction with a size-tuned blood pool contrast agent for quantitatively assessing myocardial perfusion in living mice. A perflurocarbon microbubble formulation exhibiting a narrow size distribution was developed, and echogenicity was assessed at 18 MHz in vitro. Adult mice were subjected to permanent ligation of the left anterior descending artery. Ultrasound imaging was performed on day 7, and a cohort of intact mice was used as a control. Parasternal long-axis cine clips were acquired at 18 MHz before and after contrast administration. Reduced ejection fraction and increased end-systolic volume were observed in infarcted compared with control mice. In control animals, washin of the contrast agent was visible in all myocardial segments. Reduced contrast enhancement was observed in apical-posterolateral regions of all infarcted mice. A novel method for reslicing of the imaging data through the time domain provided a two-dimensional presentation of regional contrast agent washin, enabling convenient identification of locations exhibiting altered perfusion. Myocardial segments exhibiting diminished contractility were observed to have correspondingly low relative myocardial perfusion. The contrast agent formulation and methods demonstrated here provide the basis for simplifying routine in vivo estimation of infarct size in mice and may be particularly useful in longitudinal evaluation of revascularization interventions and assessment of peri-infarct ischemia. NEW & NOTEWORTHY Murine myocardial contrast echocardiography frequently suffers from poor sensitivity to contrast. Here, we formulated a novel size-tuned microbubble contrast agent and validated it for use with ultra-high-frequency ultrasound. A novel data method for evaluating myocardial perfusion based on reslicing the imaging data through the time domain is presented.
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Affiliation(s)
- E Alvarez
- Department of Medicine, University of California , San Diego, California
| | - N D Dalton
- Department of Medicine, University of California , San Diego, California
| | - Y Gu
- Department of Medicine, University of California , San Diego, California
| | - D Smith
- Targeson, Incorporated, San Diego, California
| | - A Luong
- Targeson, Incorporated, San Diego, California
| | - M Hoshijima
- Department of Medicine, University of California , San Diego, California
| | - K L Peterson
- Department of Medicine, University of California , San Diego, California
| | - J Rychak
- Department of Bioengineering, University of California , San Diego, California.,Targeson, Incorporated, San Diego, California
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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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17
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Erbel R. Echokardiographie. Herz 2017; 42:229-231. [DOI: 10.1007/s00059-017-4557-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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18
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Prognostic Value of Myocardial Perfusion Analysis in Patients with Coronary Artery Disease: A Meta-Analysis. J Am Soc Echocardiogr 2017; 30:270-281. [DOI: 10.1016/j.echo.2016.11.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Indexed: 01/28/2023]
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Karogiannis N, Senior R. Contrast echocardiography for detection of myocardial perfusion abnormalities. Herz 2017; 42:287-294. [DOI: 10.1007/s00059-017-4536-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Vamvakidou A, Gurunathan S, Senior R. Novel techniques in stress echocardiography: a focus on the advantages and disadvantages. Expert Rev Cardiovasc Ther 2016; 14:477-94. [DOI: 10.1586/14779072.2016.1135054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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21
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Christofides D, Leen E, Averkiou MA. Evaluation of the Accuracy of Liver Lesion DCEUS Quantification With Respiratory Gating. IEEE TRANSACTIONS ON MEDICAL IMAGING 2016; 35:622-629. [PMID: 26452276 DOI: 10.1109/tmi.2015.2487866] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Confidence in the accuracy of dynamic contrast enhanced ultrasound (DCEUS) quantification parameters is imperative for the correct diagnosis of liver lesion perfusion characteristics. An important source of uncertainty in liver DCEUS acquisitions is artifacts introduced by respiratory motion. The objective of this study is to construct a respiratory motion simulation model (RMSM) of dual contrast imaging mode acquisitions of liver lesions in order to evaluate an algorithm for automatic respiratory gating (ARG). The respiratory kinetics as well as the perfusion models of the liver lesion and parenchyma used by the RMSM were solely derived from clinical data. The quality of fit (of the DCEUS data onto the bolus kinetics model) depends on the respiration amplitude. Similar trends in terms of quality of fit as a function of respiration amplitude were observed from RMSM and clinical data. The errors introduced on the DCEUS quantification under the influence of respiration were evaluated. The RMSM revealed that the error in the liver lesion DCEUS quantification parameters significantly decreased (p < 0.001) from a maximum of 32.3% to 6.2% when ARG was used. The use of RMSM clearly demonstrates the capability of the ARG algorithm in significantly reducing errors introduced from both in-plane and out-of-plane respiratory motion.
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Abdelmoneim SS, Mulvagh SL, Xie F, O’Leary E, Adolphson M, Omer MA, Nhola LF, Huang R, Warta SJ, Kirby B, Porter TR. Regadenoson Stress Real-Time Myocardial Perfusion Echocardiography for Detection of Coronary Artery Disease: Feasibility and Accuracy of Two Different Ultrasound Contrast Agents. J Am Soc Echocardiogr 2015; 28:1393-400. [DOI: 10.1016/j.echo.2015.08.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Indexed: 10/23/2022]
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Abstract
Ultrasound enhancing agents (UEAs) are being utilized for a growing number of applications with real-time very low mechanical index (MI) techniques in clinical cardiology today. This article will review recent developments on the safety of UEAs and their effectiveness in myocardial perfusion imaging, three-dimensional quantification of left ventricular function, and vascular imaging. UEAs are now being utilized in all age groups, with new indications that add incremental value to the currently approved by the Food and Drug Administration. These include the incremental value in cardiac imaging, where the off-label analysis of myocardial perfusion observed with UEAs adds to the enhanced endocardial border delineation. In carotid artery imaging, UEAs improve the detection of plaque but also can examine plaque neovascularization. Vascular surgeons now utilize UEAs in the evaluation of endovascular repair to detect endoleaks without the need of ionizing radiation. Newer applications are emerging in the detection of left atrial appendage thrombi and quantification of myocardial blood flow and volume in transplant patients.
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Affiliation(s)
- Thomas R Porter
- Division of Cardiology, University of Nebraska Medical Center, Omaha, NE, 68198, USA,
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Abstract
Microbubbles are an excellent intravascular tracer, and both the rate of myocardial opacification (analogous to coronary microvascular perfusion) and contrast intensity (analogous to myocardial blood volume) provide unique insights into myocardial perfusion. A strong evidence base has been accumulated to show comparability with nuclear perfusion imaging and incremental diagnostic and prognostic value relative to wall motion analysis. This technique also provides the possibility to measure myocardial perfusion at the bedside. Despite all of these advantages, the technique is complicated, technically challenging, and has failed to scale legislative and financial hurdles. The development of targeted imaging and therapeutic interventions will hopefully rekindle interest in this interesting modality.
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Affiliation(s)
- Faraz Pathan
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Thomas H Marwick
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
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Cosco D, Fattal E, Fresta M, Tsapis N. Perfluorocarbon-loaded micro and nanosystems for medical imaging: A state of the art. J Fluor Chem 2015. [DOI: 10.1016/j.jfluchem.2014.10.013] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Affiliation(s)
- Diwakar Jain
- Cardiovascular Nuclear Imaging Laboratory, New York Medical College, Westchester Medical Center, Macy Pavilion 111, 100 Woods Road, Valhalla, NY, 10595, USA,
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Ultrasound molecular imaging of transient acute myocardial ischemia with a clinically translatable P- and E-selectin targeted contrast agent: correlation with the expression of selectins. Invest Radiol 2014; 49:224-35. [PMID: 24442162 DOI: 10.1097/rli.0000000000000018] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The diagnosis of acute coronary syndrome remains challenging especially in patients without clear symptoms or electrocardiographic and/or biomarker features. A hallmark of ischemia/reperfusion is activation of endothelial cells leading to altered expression of molecular markers, including selectins. In this context, we aimed to validate the value of ultrasound molecular imaging for detecting transient myocardial ischemia by using a clinically translatable dual P- and E-selectin-targeted ultrasound contrast agent (UCA) and microbubble (MB(selectin)). MATERIAL AND METHODS Transient (20 minutes) myocardial ischemia of rat heart was produced by ligation of the left anterior descending coronary artery ligation followed by 2-, 5-, or 24-hour reperfusion. Imaging of the transient ischemic event was achieved by the use of MB(selectin). Performance of this clinically translatable targeted UCA was compared with that of antibody-targeted streptavidin MBs. Finally, immunohistochemistry staining of rat myocardial ischemic tissue was performed to assess expression of selectins accessible to targeted UCA. RESULTS In rats subjected to myocardial ischemia (20 minutes) followed by reperfusion (2 hours), injection of MB(selectin) produced high late phase (ie, 10-minute postinjection) ultrasound molecular imaging enhancement in the myocardium, which colocalized with the ischemic area. Late phase enhancement persisted 5 and 24 hours after reperfusion. Similarly, the use of MBP and MBE, comprising antibodies specific for P- and E-selectin, respectively, showed high late-phase enhancement within the ischemic area compared with remote myocardial tissue. Two and 5 hours after ischemia has resolved, a persistent expression of these 2 selectins was detected. After 24 hours of reperfusion, only MBE produced late phase enhancement within the ischemic myocardium. Immunohistochemical findings revealed that both P- and E-selectin were expressed and accessible on the surface of the activated endothelium 2 and 5 hours after the acute ischemic event, whereas only E-selectin remained accessible after 24 hours. CONCLUSIONS Ultrasound molecular imaging of transient myocardial ischemia using dual selectin-targeted UCA is able to monitor the time course of expression of selectins after resolution of the ischemic event, paving the way for a large clinical diagnostic window.
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Shah BN, Chahal NS, Bhattacharyya S, Li W, Roussin I, Khattar RS, Senior R. The feasibility and clinical utility of myocardial contrast echocardiography in clinical practice: results from the incorporation of myocardial perfusion assessment into clinical testing with stress echocardiography study. J Am Soc Echocardiogr 2014; 27:520-30. [PMID: 24637056 DOI: 10.1016/j.echo.2014.01.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Indexed: 01/30/2023]
Abstract
BACKGROUND This prospective study investigated whether the incorporation of myocardial contrast echocardiography (MCE) into a clinical stress echocardiography service reproduces the benefits of assessing myocardial perfusion proved previously in research studies. METHODS MCE was performed during physiologic and pharmacologic clinical stress echocardiographic studies, and the value of myocardial perfusion to the reporting echocardiologists was categorized as of benefit (subclassified as incremental benefit over wall motion [WM] or greater confidence with WM) or of no added benefit. The presence and extent of inducible ischemia by WM and myocardial perfusion were documented and correlated with angiographic results in patients who underwent cardiac catheterization. RESULTS In total, 220 patients underwent simultaneous MCE during stress echocardiography by eight different operators. Overall, MCE was of benefit in 193 patients (88%), providing incremental benefit over WM in 25% and greater confidence with WM evaluation in 62%. MCE provided no added benefit in 27 patients (12%). MCE detected significantly more cases of ischemia than WM in the left anterior descending coronary artery territory (65% vs 53%, P = .02) and detected a greater ischemic burden than WM on a per patient basis (median, 5 [interquartile range, 3-8] vs 4 [interquartile range, 2-7] segments; P < .001) and across all coronary territories. MCE correctly identified a greater proportion of patients with multivessel disease than WM (76% vs 56%, P = .02) and a greater ischemic burden in patients with multivessel disease (median, 7 [interquartile range, 4-9] vs 5 [interquartile range, 1-8] segments; P < .001). CONCLUSIONS This prospective study is the first to demonstrate that the excellent feasibility and diagnostic utility of MCE, which have been documented in the research arena, are reproducible in the clinical arena.
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Affiliation(s)
- Benoy N Shah
- Department of Echocardiography, Royal Brompton Hospital, London, United Kingdom; Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom; National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Navtej S Chahal
- Department of Echocardiography, Royal Brompton Hospital, London, United Kingdom
| | | | - Wei Li
- Department of Echocardiography, Royal Brompton Hospital, London, United Kingdom
| | - Isabelle Roussin
- Department of Echocardiography, Royal Brompton Hospital, London, United Kingdom
| | - Rajdeep S Khattar
- Department of Echocardiography, Royal Brompton Hospital, London, United Kingdom; National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Roxy Senior
- Department of Echocardiography, Royal Brompton Hospital, London, United Kingdom; Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom; National Heart and Lung Institute, Imperial College, London, United Kingdom.
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Christofides D, Leen E, Averkiou M. Automatic respiratory gating for contrast ultrasound evaluation of liver lesions. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2014; 61:25-32. [PMID: 24402893 DOI: 10.1109/tuffc.2014.6689773] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Dynamic contrast-enhanced ultrasound (DCEUS) has been used in radiology for many years for lesion detection and characterization. In recent years, more emphasis has been placed on tumor perfusion quantification with DCEUS. To ensure accuracy in both quantitative and qualitative evaluation of liver tumors with DCEUS, sources of noise in clinical data must be identified and, if possible, removed. One of the major sources of such noise is respiratory motion. A new automatic respiratory gating (ARG) algorithm is presented and evaluated with clinical data. The results of the evaluation demonstrate the potential of the ARG algorithm for clinical use as a fast and easy-to-implement method for removing respiratory motion from DCEUS loops.
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Becher H, Gibson PH. Contrast Echocardiography: Current Applications and Future Perspectives. CURRENT CARDIOVASCULAR IMAGING REPORTS 2013. [DOI: 10.1007/s12410-013-9234-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bhattacharyya S, Senior R. The current state of myocardial contrast echocardiography: what can we read between the lines? Reply. Eur Heart J Cardiovasc Imaging 2013; 15:351-2. [PMID: 24520155 DOI: 10.1093/ehjci/jet249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Sanjeev Bhattacharyya
- Department of Cardiology and Echocardiography Laboratory, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
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Klibanov AL. Ultrasound contrast materials in cardiovascular medicine: from perfusion assessment to molecular imaging. J Cardiovasc Transl Res 2013; 6:729-39. [PMID: 23913363 DOI: 10.1007/s12265-013-9501-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 07/08/2013] [Indexed: 11/26/2022]
Abstract
Ultrasound imaging is widely used in cardiovascular diagnostics. Contrast agents expand the range of tasks that ultrasound can perform. In the clinic in the USA, endocardial border delineation and left ventricle opacification have been an approved indication for more than a decade. However, myocardial perfusion contrast ultrasound studies are still at the clinical trials stage. Blood pool contrast and perfusion in other tissues might be an easier indication to achieve: general blood pool ultrasound contrast is in wider use in Europe, Canada, Japan, and China. Targeted (molecular) contrast microbubbles will be the next generation of ultrasound imaging probes, capable of specific delineation of the areas of disease by adherence to molecular targets. The shell of targeted microbubbles (currently in the preclinical research and early stage clinical trials) is decorated with the ligands (antibodies, peptides or mimetics, hormones, and carbohydrates) that ensure firm binding to the molecular markers of disease.
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Affiliation(s)
- Alexander L Klibanov
- Division of Cardiovascular Medicine and Cardiovascular Research Center, University of Virginia School of Medicine, Charlottesville, VA, 22908, USA,
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Bhattacharyya S, Chehab O, Khattar R, Lloyd G, Senior R. Stress echocardiography in clinical practice: a United Kingdom National Health Service Survey on behalf of the British Society of Echocardiography. Eur Heart J Cardiovasc Imaging 2013; 15:158-63. [DOI: 10.1093/ehjci/jet082] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Comparison of sulfur hexafluoride microbubble (SonoVue)-enhanced myocardial contrast echocardiography with gated single-photon emission computed tomography for detection of significant coronary artery disease: a large European multicenter study. J Am Coll Cardiol 2013; 62:1353-61. [PMID: 23770168 DOI: 10.1016/j.jacc.2013.04.082] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 04/05/2013] [Accepted: 04/23/2013] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The purpose of this study was to compare sulfur hexafluoride microbubble (SonoVue)-enhanced myocardial contrast echocardiography (MCE) with single-photon emission computed tomography (SPECT) relative to coronary angiography (CA) for assessment of coronary artery disease (CAD). BACKGROUND Small-scale studies have shown that myocardial perfusion assessed by SonoVue-enhanced MCE is a viable alternative to SPECT for CAD assessment. However, large multicenter studies are lacking. METHODS Patients referred for myocardial ischemia testing at 34 centers underwent rest/vasodilator SonoVue-enhanced flash-replenishment MCE, standard (99m)Tc-labeled electrocardiography-gated SPECT, and quantitative CA within 1 month. Myocardial ischemia assessments by 3 independent, blinded readers for MCE and 3 readers for SPECT were collapsed into 1 diagnosis per patient per technique and were compared to CA (reference standard) read by 1 independent blinded reader. RESULTS Of 628 enrolled patients who received SonoVue (71% males; mean age: 64 years; >1 cardiovascular [CV] risk factor in 99% of patients) 516 patients underwent all 3 examinations, of whom 161 (31.2%) had ≥70% stenosis (131 had single-vessel disease [SVD]; 30 had multivessel disease), and 310 (60.1%) had ≥50% stenosis. Higher sensitivity was obtained with MCE than with SPECT (75.2% vs. 49.1%, respectively; p < 0.0001), although specificity was lower (52.4% vs. 80.6%, respectively; p < 0.0001) for ≥70% stenosis. Similar findings were obtained for patients with ≥50% stenosis. Sensitivity levels for detection of SVD and proximal disease for ≥70% stenosis were higher for MCE (72.5% vs. 42.7%, respectively; p < 0.0001; 80% vs. 58%, respectively; p = 0.005, respectively). CONCLUSIONS SonoVue-enhanced MCE demonstrated superior sensitivity but lower specificity for detection of CAD compared to SPECT in a population with a high incidence of CV risk factors and intermediate-high prevalence of CAD. (A phase III study to compare SonoVue® enhanced myocardial echocardiography [MCE] to single photon emission computerized tomography [ECG-GATED SPECT], at rest and at peak of low-dose Dipyridamole stress test, in the assessment of significant coronary artery disease [CAD] in patients with suspect or known CAD using Coronary Angiography as Gold Standard-SonoVue MCE vs SPECT; EUCTR2007-003492-39-GR).
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Thomas JD. Myocardial contrast echocardiography perfusion imaging: still waiting after all these years. J Am Coll Cardiol 2013; 62:1362-4. [PMID: 23770171 DOI: 10.1016/j.jacc.2013.05.053] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 05/16/2013] [Accepted: 05/21/2013] [Indexed: 01/26/2023]
Affiliation(s)
- James D Thomas
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
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Chong A, Haluska B, Wahi S. Clinical application and laboratory protocols for performing contrast echocardiography. Indian Heart J 2013; 65:337-46. [PMID: 23809394 PMCID: PMC3861153 DOI: 10.1016/j.ihj.2013.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 04/03/2013] [Indexed: 10/27/2022] Open
Abstract
Technically difficult echocardiographic studies with suboptimal images remain a significant challenge in clinical practice despite advances in imaging technologies over the past decades. Use of microbubble ultrasound contrast for left ventricular opacification and enhancement of endocardial border detection during rest or stress echocardiography has become an essential component of the operation of the modern echocardiography laboratory. Contrast echocardiography has been demonstrated to improve diagnostic accuracy and confidence across a range of indications including quantitative assessment of left ventricular systolic function, wall motion analysis, and left ventricular structural abnormalities. Enhancement of Doppler signals and myocardial contrast echocardiography for perfusion remain off-label uses. Implementation of a contrast protocol is feasible for most laboratories and both physicians and sonographers will require training in contrast specific imaging techniques for optimal use. Previous concerns regarding the safety of contrast agents have since been addressed by more recent data supporting its excellent safety profile and overall cost-effectiveness.
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Affiliation(s)
| | | | - Sudhir Wahi
- Department of Cardiology, Princess Alexandra Hospital, School of Medicine, University of Queensland, 199 Ipswich Road, Woolloongabba, Brisbane 4102, Australia
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Echocardiography and Vascular Ultrasound: New Developments and Future Directions. Can J Cardiol 2013; 29:304-16. [DOI: 10.1016/j.cjca.2012.11.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 10/22/2012] [Accepted: 11/02/2012] [Indexed: 12/15/2022] Open
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Lanza GA, Camici PG, Galiuto L, Niccoli G, Pizzi C, Di Monaco A, Sestito A, Novo S, Piscione F, Tritto I, Ambrosio G, Bugiardini R, Crea F, Marzilli M. Methods to investigate coronary microvascular function in clinical practice. J Cardiovasc Med (Hagerstown) 2013; 14:1-18. [DOI: 10.2459/jcm.0b013e328351680f] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Berman DS, Maddahi J, Tamarappoo BK, Czernin J, Taillefer R, Udelson JE, Gibson CM, Devine M, Lazewatsky J, Bhat G, Washburn D. Phase II safety and clinical comparison with single-photon emission computed tomography myocardial perfusion imaging for detection of coronary artery disease: flurpiridaz F 18 positron emission tomography. J Am Coll Cardiol 2012; 61:469-477. [PMID: 23265345 DOI: 10.1016/j.jacc.2012.11.022] [Citation(s) in RCA: 132] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 11/21/2012] [Accepted: 11/22/2012] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This was a phase II trial to assess flurpiridaz F 18 for safety and compare its diagnostic performance for positron emission tomography (PET) myocardial perfusion imaging (MPI) with Tc-99m single-photon emission computed tomography (SPECT) MPI with regard to image quality, interpretative certainty, defect magnitude, and detection of coronary artery disease (CAD) (≥50% stenosis) on invasive coronary angiography (ICA). BACKGROUND In pre-clinical and phase I studies, flurpiridaz F 18 has shown characteristics of an essentially ideal MPI tracer. METHODS One hundred forty-three patients from 21 centers underwent rest-stress PET and Tc-99m SPECT MPI. Eighty-six patients underwent ICA, and 39 had low-likelihood of CAD. Images were scored by 3 independent, blinded readers. RESULTS A higher percentage of images were rated as excellent/good on PET versus SPECT on stress (99.2% vs. 88.5%, p < 0.01) and rest (96.9% vs. 66.4, p < 0.01) images. Diagnostic certainty of interpretation (percentage of cases with definitely abnormal/normal interpretation) was higher for PET versus SPECT (90.8% vs. 70.9%, p < 0.01). In 86 patients who underwent ICA, sensitivity of PET was higher than SPECT (78.8% vs. 61.5%, respectively, p = 0.02). Specificity was not significantly different (PET: 76.5% vs. SPECT: 73.5%). Receiver-operating characteristic curve area was 0.82 ± 0.05 for PET and 0.70 ± 0.06 for SPECT (p = 0.04). Normalcy rate was 89.7% with PET and 97.4% with SPECT (p = NS). In patients with CAD on ICA, the magnitude of reversible defects was greater with PET than SPECT (p = 0.008). Extensive safety assessment revealed that flurpiridaz F 18 was safe in this cohort. CONCLUSIONS In this phase 2 trial, PET MPI with flurpiridaz F 18 was safe and superior to SPECT MPI for image quality, interpretative certainty, and overall CAD diagnosis.
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Affiliation(s)
- Daniel S Berman
- Departments of Imaging and Medicine, the Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
| | - Jamshid Maddahi
- Departments of Molecular Medicine and Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - B K Tamarappoo
- Departments of Imaging and Medicine, the Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Johannes Czernin
- Departments of Molecular Medicine and Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | | | - James E Udelson
- Division of Cardiology and the CardioVascular Center, Tufts Medical Center, Boston, Massachusetts
| | | | | | | | - Gajanan Bhat
- Lantheus Medical Imaging, North Billerica, Massachusetts
| | - Dana Washburn
- Lantheus Medical Imaging, North Billerica, Massachusetts
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40
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Microbubbles as ultrasound contrast agents for molecular imaging: preparation and application. AJR Am J Roentgenol 2012; 199:292-9. [PMID: 22826389 DOI: 10.2214/ajr.12.8826] [Citation(s) in RCA: 129] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The purpose of this review is to describe trends in microbubble application in molecular imaging. CONCLUSION Microbubbles are used for contrast ultrasound imaging as blood-pool agents in cardiology and radiology. Their promise as targeted agents for molecular imaging is now being recognized. Microbubbles can be functionalized with ligand molecules that bind to molecular markers of disease. Potential clinical applications of molecular imaging with microbubble-based ultrasound contrast agents are in the monitoring of the biomarker status of vascular endothelium, visualizing tumor vasculature, and imaging inflammation and ischemia-reperfusion injury zones and thrombi.
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Løgstrup BB, Høfsten DE, Christophersen TB, Møller JE, Bøtker HE, Pellikka PA, Egstrup K. Correlation between left ventricular global and regional longitudinal systolic strain and impaired microcirculation in patients with acute myocardial infarction. Echocardiography 2012; 29:1181-90. [PMID: 22862151 DOI: 10.1111/j.1540-8175.2012.01784.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES We investigated the correlation between left ventricular global and regional longitudinal systolic strain (GLS and LRS) and coronary flow reserve (CFR) assessed by transthoracic echocardiography (TTE) in patients with a recent acute myocardial infarction (AMI). Furthermore, we investigated if LRS and GLS imaging is superior to conventional measures of left ventricle (LV) function. METHODS In a consecutive population of first time AMI patients, who underwent successful revascularization, we performed comprehensive TTE. GLS and LRS were obtained from the three standard apical views. Assessment of CFR by TTE was performed in a modified apical view using color Doppler guidance. RESULTS The study population consisted of 183 patients (51 females) with a median age of 63 [54;70] years. Eighty-nine (49%) patients had a non-ST elevation myocardial infarction and 94 (51%) patients had a ST elevation myocardial infarction. The GLS was -15.2 [-19.3;-10.1]% in the total population of 183 patients. Total wall motion score index (WMSI) in the population was 1.19 [1;1.5]. Eighty-five patients suffered from culprit lesion in left anterior descending artery (LAD). The CFR in these patients was 1.86 [1.36;2.35] and the GLS was -14.3 [-18.9; -9.8]%. A significant difference was observed in the LRS in LAD territory in culprit LAD infarction patients with a CFR ≤ 2 (-9.6 [-13.77;-6.44]) compared with the LRS in LAD territory in culprit LAD infarction patients with a CFR > 2 (-19.33 [-21.1;-16.5]), P < 0.0001. We found no significant difference between WMSI in LAD territory in culprit LAD infarction patients with a CFR ≤ 2 (1.56 [1.06;2.23]) compared with WMSI in LAD territory in culprit LAD infarction patients with a CFR > 2 (1.37 [1.03;2.11]); P = 0.18. The same pattern was observed in both circumflex coronary artery (CX) and right coronary artery (RCA) territories. In the total population, we found a strong correlation between CFR and GLS (r = -0.85, P < 0.0001). This was also seen in the multivariate regression model adjusting for possible confounders including WMSI (P < 0.001). CONCLUSION In this study, we have shown a close association between myocardial deformation in patients with a recent AMI and the degree of diminished microcirculation. We found that both GLS and LRS correlated with CFR. We conclude that GLS and LRS are significantly better tools to assess impaired CFR and LV function after a recent AMI, than conventional echocardiographic measurements.
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Affiliation(s)
- Brian B Løgstrup
- Department of Medical Research, Odense University Hospital, Svendborg, Denmark
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Shah BN, Senior R. Bolus injection or continuous infusion for the assessment of myocardial blood flow during perfusion stress echocardiography? Eur Heart J Cardiovasc Imaging 2011; 13:118; author reply 118-9. [DOI: 10.1093/ejechocard/jer279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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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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Gaibazzi N, Squeri A, Reverberi C, Molinaro S, Lorenzoni V, Sartorio D, Senior R. Contrast stress-echocardiography predicts cardiac events in patients with suspected acute coronary syndrome but nondiagnostic electrocardiogram and normal 12-hour troponin. J Am Soc Echocardiogr 2011; 24:1333-41. [PMID: 22014426 DOI: 10.1016/j.echo.2011.09.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Indexed: 12/29/2022]
Abstract
BACKGROUND No large study has demonstrated that any stress test can risk-stratify future hard cardiac events (cardiac death or myocardial infarction) in patients with suspected acute coronary syndromes (ACS), nondiagnostic electrocardiographic (ECG) findings, and normal troponin levels. The aim of this study was to test the hypothesis that combined contrast wall motion and myocardial perfusion echocardiographic assessment (cMCE) during stress echocardiography can predict long-term hard cardiac events in patients with suspected ACS, nondiagnostic ECG findings, and normal troponin. METHODS A total of 545 patients referred for contrast stress echocardiography from the emergency department for suspected ACS but nondiagnostic ECG findings and normal troponin levels at 12 hours were followed up for cardiac events. Patients underwent dipyridamole-atropine echocardiography with adjunctive myocardial perfusion imaging using a commercially available ultrasound contrast medium (SonoVue). RESULTS During a median follow-up period of 12 months, 25 cardiac events (4.6%) occurred (no deaths, 12 nonfatal myocardial infarctions, 13 episodes of unstable angina). Abnormal findings on cMCE were the most significant predictor of both hard cardiac events (hazard ratio, 22.8; 95% confidence interval, 2.9-176.7) and the combined (cardiac death, myocardial infarction, or unstable angina requiring revascularization) end point (hazard ratio, 10.7; 95% confidence interval, 3.7-31.3). The inclusion of the cMCE variable significantly improved multivariate models, determining lower Akaike information criterion values and higher discrimination ability. CONCLUSIONS cMCE during contrast stress echocardiography provided independent information for predicting hard and combined cardiac events beyond that predicted by stress wall motion abnormalities in patients with suspected ACS, nondiagnostic ECG findings, and normal troponin levels.
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Affiliation(s)
- Nicola Gaibazzi
- Department of Cardiology, Parma University Hospital, Parma, Italy.
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Udelson JE. Ninth annual Mario S. Verani memorial lecture : testing our tests: the evidence bar is rising. Regulatory considerations in the development of cardiac imaging agents. J Nucl Cardiol 2011; 18:547-60. [PMID: 21638150 DOI: 10.1007/s12350-011-9404-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- James E Udelson
- The Division of Cardiology and the CardioVascular Center, Tufts Medical Center, Box 70, 800 Washington St., Boston, MA 02111, USA.
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Chitnis PV, Lee P, Mamou J, Allen JS, Böhmer M, Ketterling JA. Rupture threshold characterization of polymer-shelled ultrasound contrast agents subjected to static overpressure. JOURNAL OF APPLIED PHYSICS 2011; 109:84906-8490610. [PMID: 21580800 PMCID: PMC3094458 DOI: 10.1063/1.3565062] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Accepted: 02/13/2011] [Indexed: 05/20/2023]
Abstract
Polymer-shelled micro-bubbles are employed as ultrasound contrast agents (UCAs) and vesicles for targeted drug delivery. UCA-based delivery of the therapeutic payload relies on ultrasound-induced shell rupture. The fragility of two polymer-shelled UCAs manufactured by Point Biomedical or Philips Research was investigated by characterizing their response to static overpressure. The nominal diameters of Point and Philips UCAs were 3 μm and 2 μm, respectively. The UCAs were subjected to static overpressure in a glycerol-filled test chamber with a microscope-reticule lid. UCAs were reconstituted in 0.1 mL of water and added over the glycerol surface in contact with the reticule. A video-microscope imaged UCAs as glycerol was injected (5 mL∕h) to vary the pressure from 2 to 180 kPa over 1 h. Neither UCA population responded to overpressure until the rupture threshold was exceeded, which resulted in abrupt destruction. The rupture data for both UCAs indicated three subclasses that exhibited different rupture behavior, although their mean diameters were not statistically different. The rupture pressures provided a measure of UCA fragility; the Philips UCAs were more resilient than Point UCAs. Results were compared to theoretical models of spherical shells under compression. Observed variations in rupture pressures are attributed to shell imperfections. These results may provide means to optimize polymeric UCAs for drug delivery and elucidate associated mechanisms.
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Cosgrove D, Lassau N. Imaging of perfusion using ultrasound. Eur J Nucl Med Mol Imaging 2010; 37 Suppl 1:S65-85. [PMID: 20640418 DOI: 10.1007/s00259-010-1537-7] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Ultrasound can be used to image perfusion in two ways: the traditional one using Doppler and the more recent using microbubble contrast agents. Doppler is simple to use and inexpensive but is limited to larger vessels with faster flow rates. It cannot interrogate the microvasculature because bulk tissue movement is faster than capillary flow. It has been used for liver and tumour flow. Contrast studies are much richer and can assess both the macro- and microcirculation. One approach analyses the time-intensity curves in a region of interest, e.g. a tumour, myocardium, brain, following bolus i.v. injection. Another approach measures the time taken for the microbubbles to cross a vascular bed of interest. These arrival times can be useful for the liver in both diffuse and focal diseases and for the kidney. Features derived from time-intensity curves following bolus i.v. injections of microbubbles form sensitive early indicators of the vascular response of tumours to antivascular drugs. This approach, known as dynamic contrast-enhanced ultrasound (DCE-US), has been accepted as a valid technique for monitoring tumour response by several authorities.
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Affiliation(s)
- David Cosgrove
- Imaging Sciences Department, Imperial College, Hammersmith Hospital, London, UK.
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Gaibazzi N, Rigo F, Reverberi C. Detection of Coronary Artery Disease by Combined Assessment of Wall Motion, Myocardial Perfusion and Coronary Flow Reserve: A Multiparametric Contrast Stress-Echocardiography Study. J Am Soc Echocardiogr 2010; 23:1242-50. [DOI: 10.1016/j.echo.2010.09.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Indexed: 11/16/2022]
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The Year in Coronary Artery Disease. JACC Cardiovasc Imaging 2010; 3:1065-77. [DOI: 10.1016/j.jcmg.2010.08.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Revised: 07/27/2010] [Accepted: 08/30/2010] [Indexed: 01/29/2023]
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Anantharam B, Janardhanan R, Hayat S, Hickman M, Chahal N, Bassett P, Senior R. Coronary flow reserve assessed by myocardial contrast echocardiography predicts mortality in patients with heart failure. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2010; 12:69-75. [DOI: 10.1093/ejechocard/jeq109] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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