Contrast Echocardiography Contrast Echocardiography

Contrast Echocardiography

Jean-Louis J. Vanoverschelde, MD, PhD Université catholique de Louvain Brussels, Belgium

Contrast Echocardiography Relation of µ bubbles to red blood cells 1.00

102 x 120 100 80

Transit time of µ bubbles

8.108 ml-1 4.3 µ m

60 40 20 0 0

2

4

6

Diameter (µ m)

8

10

0.75

0.50

0.25

0.00 0.0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

Transit time of red blood cells Jayaweera et al. Circ. Res. 1994

Contrast Echocardiography Effect of low acoustic energy on µ bubbles size

ultrasound pressure

µ bubble radius

rarefaction compression

Contrast Echocardiography Effect of high acoustic energy on µ bubbles

ultrasound pressure

µ bubble radius

rarefaction compression

Contrast Echocardiography Effect of acoustic energy on µ bubbles scattering properties

µ bubble destruction Stimulated acoustic emission 1MPa

MI > 1.0

Non-linear scattering properties Harmonic frequency 100 kPa

MI < 0.3

Non-linear scattering properties Fundamental and harmonic frequencies 0 kPa

Contrast Echocardiography Destruction of contrast by ultrasound

Intensity (dB)

24

16

8

0 0

80

160

240

Time (ms)

320


• • •

Left ventricular opacification Myocardial perfusion Assessment of reperfusion and myocardial viability

Contrast Echocardiography Left ventricular opacification

Improved endocardial border delineation • reduced inter- and intra-observer variability • improved detection of regional wall motion abnormalities • improved calculation of LV volumes and ejection fraction

Contrast Echocardiography Inter-institutional agreement according to image quality 120

Agreement in %

100 80 60 40 20 0

A

B

C

D

E Hoffmann et al. J Am Coll Cardiol 1996;27:330



Contrast Echocardiography NA, 67 y.o. male

Contrast Echocardiography NA, 67 y.o. male

Contrast Echocardiography Effect of left ventricular opacification on accuracy of DbE 100

* 80

LVO

40

no LVO

(%)

60

20

0 % WTh

Sensitivity Specificity Accuracy Dolan et al. Am Heart J 2001;142:908


• • •

Left ventricular opacification Myocardial perfusion Assessment of reperfusion and myocardial viability

Contrast Echocardiography Real-time perfusion imaging using power modulation

Contrast Echocardiography MCE versus MIBI for assessment of myocardial blood volume 5 MCE MBV 99mTcTc-MIBI

LAD adenosine

LAD / Cx ratio

LAD stenosis + adenosine

4

µ spheres

3

2

1 LAD occlusion 0 LAD Ado

LAD stenosis + Ado

occlusion

Wei et al. Am J Physiol 2001,280:H1896.


How do we get from myocardial blood volume to myocardial blood flow ?

DYNAMIC IMAGING

Contrast Echocardiography Quantification of myocardial blood flow Flash

1st cardiac 2nd cardiac 3rd cardiac 4th cardiac cycle cycle cycle cycle

time

5th cardiac cycle


Van Camp et al., JASE 2003;16:263



Contrast Echocardiography Real-time perfusion imaging using power modulation Stenosis + Adenosine

18

Video intensity

16 14 12 10 8 6 4 2 0 0

2

4

6

8

10

12

14

16

18

Time (s) Van Camp et al., JASE 2003;16:263

Contrast Echocardiography Real-time perfusion imaging using power modulation 1.75

25

y = 0.45x - 6.26 r = 0.93

1.50

y = 5.91x - 0.69 r = 0.91

A x β (dB·s-1)

β slope (s-1)

20 1.25 1.00 0.75 0.50

15

10

5 0.25 0.00

0 0

1

2

3

4

0

1

2

3

Microsphere blood flow

Microsphere blood flow

(ml.min-1.g-1)

(ml.min-1.g-1)

4


Contrast Echocardiography MN, 50 y.o. male

Peltier et al. JACC 2004;43:257

Contrast Echocardiography MN, 50 y.o. male DIPYRIDAMOLE MCE



DIPYRIDAMOLE SPECT



DIPYRIDAMOLE SPECT


Contrast Echocardiography Dipyridamole real-time Power Modulation 12

Videointensity (dB)

10 8 6 4 2 0 0

2

4

6

8

10

Time (s)

12

14

16

18


Contrast Echocardiography Dipyridamole real-time Power Modulation 1.25 n=292

β slope (s-1)

1.00

n=32

n=92

n=42

* *

0.75

*† *†

0.50 0.25 0.00 Rest Dip

Rest Dip

Rest Dip

Rest Dip

< 50%

50-70%

70-90%

> 90% Peltier et al. JACC 2004;43:257

Contrast Echocardiography Dipyridamole real-time Power Modulation

β reserve

3

2

1 0.09(x-100)) y = 2.65 (1(1-e-0.09(xr = 0.85

0 0

20

40

60

80

100

% luminal diameter stenosis Peltier et al. JACC 2004;43:257

Contrast Echocardiography Dipyridamole real-time Power Modulation

Sensitivity (%)

β reserve

A * β reserve

100

100

75

75

50

50

Area under the curve =0.85

25

Area under the curve =0.86

25

0

0 100

75

50

25

Specificity (%)

0

100

75

50

25

0

Specificity (%) Peltier et al. JACC 2004;43:257

Contrast Echocardiography Dipyridamole RTCE: Prognostic implications 100

Normal MP

Event fre survival (%)

Fixed perfusion defect

80

Inducible perfusion defect

60

40 Fixed + inducible perfusion defect

20 P