Coronary microcirculation dysfunction evaluated by myocardial contrast echocardiography predicts poor prognosis in patients with ST-segment elevation myocardial infarction after percutaneous coronary intervention

Contrast Echocardiography in Heart Failure: Update 2023

PURPOSE OF REVIEW

The application of ultrasound-enhancing agents (contrast agents) has improved the accuracy and reproducibility of echocardiography. The review focuses on the currently approved and evolving indications for contrast echocardiography in patients with heart failure, specifically examining clinical studies conducted after the publication of the guidelines in 2017 and 2018.

RECENT FINDINGS

The current ASE/EACVI recommendations for contrast echocardiography are based on its accuracy and reproducibility in comparison to non-enhanced echocardiography or other imaging modalities like cardiac MRI. However, tissue characterization remains limited with contrast echocardiography. During the last few years, several studies have demonstrated the clinical impact of using contrast agents on the management of patients with heart failure. There is growing evidence on the benefit of using contrast echocardiography in critically ill patients where echocardiography without contrast agents is often suboptimal and other imaging methods are less feasible. There is no risk of worsening renal function after the administration of ultrasound-enhancing agents, and these agents can be administered even in patients with end-stage renal disease. Contrast echocardiography has become a valuable tool for first-line imaging of patients with heart failure across the spectrum of patients with chronic heart failure to critically ill patients.

Synchronous recording of magnetocardiographic and electrocardiographic signals

We present a system for simultaneous recording of the electrocardiogram and the magnetocardiogram. The measurement system contained of printed carbon electrodes and SERF magnetometer. The use of this system confirms that the position of the end of the magnetic T wave extends further than the electric T wave, which is an important indicator for the diagnosis of cardiological patients and for drug arrhythmogenicity. We analyze this phenomenon in depth, and demonstrate, that it originates from the fundamental difference between electric and magnetic measurements. The measured value is always bipolar since the electric measurements require two electrodes. We demonstrate how the dual electric and magnetic measuring system adds a new information to the commonly used electrocardiographic diagnosis. The ECG should be interpreted as the spatial asymmetry of the electric cardiac potential, and not as the potential itself. The results seem to prove, that the relation between the magnetic and the electric imaging of neural activities may be broadly applied for the benefit of medical diagnosis in cardiology and many other fields, where the neural activity is measured. This is a pilot study which requires further confirmation at the clinical level.