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Contrast for assessment of Left Ventricular structure and function

Summary

Summary of this chapter's five clinical cases, and evidence-based recommendations by the European Association of Echocardiography. Chapter extract from EAE Recommendations: "Contrast echocardiography : Evidence-based recommendations by European Association of Echocardiography"

Authors: Roxy Senior, Harald Becher, Mark Monaghan, Luciano Agati, Jose Zamorano, Jean Louis Vanoverschelde, and Petros Nihoyannopoulos

 

In patients with suboptimal images

  • To enable improved endocardial visualization and assessment of LV structure and function when two or more contiguous
  • segments are NOTseen on non-contrast images
  • To have accurate and repeatable measurements of LV volumes, and ejection fraction by 2D Echo
  • To increase confidence of the interpreting physician in the LV function, structure and volume assessments
  • To confirm or exclude the echocardiographic diagnosis of the following LV structural abnormalities, when non-enhanced images are suboptimal for definitive diagnosis:
    • apical hypertrophic cardiomyopathy
    • ventricular non-compaction
    • apical thrombus
    • ventricular pseudoaneurysm

Link to Clinical Case 1

60year old male. Hypertensive, diabetic, overweight. Referred for echocardiography to investigate breathlessness. Sub-optimal apical image quality, then was contrast used for image optimisation.

Link to Clinical Case 2

45 year old male, 164 cm/155 kg – Body mass index 57.6, Past AMI and established heart failure: EF 40 % (2000), Drug abuse in the past, Admitted due to shortness of breath, Not taken “some medications”

Link to Clinical Case 3

80 year old male, Smoker, Admitted due to suspected Heart Failure November 2007, Echo : Severely decreased systolic LV function, EF 15%, Normal angiogram (Non-ischemic dilated cardiomyopathy), Numerous runs of non-sustained VT : Scheduled for ICD, Medication led to a clinical improvement; NYHA IIIb & II, No remaining VT episodes during mobilisation

Link to Clinical Case 4

54 year old male teacher. Seen in Cardiology Outpatients for assessment due to fatigue and shortness of breath. Heart failure symptoms and signs, referred for echocardiography.

Link to Clinical Case 5

70 year old female, Referral for echocardiogram due to fatigue and shortness of breath.

Conclusions

  • There is evidence to support the use of contrast agents in enhancing 2D echo stuides for superior assessment of LV structure and function.
  • Particular benefits are seen with:
    • Endocardial definition for ejection fraction
    • Apical thrombus assessment
    • Structural defects such as apical HCM or non-compaction cardiomyopathy