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New applications

Teaching Course on contrast echocardiography

  • Fundamentals of molecular imaging using contrast echocardiography, presented by J R Lindner (Portland, US)  
  • Stem cell and gene therapy, presented by K Tiemann (Munich, DE)  
  • Plaque vulnerability, presented by S B Feinstein (Chicago, US)  
  • Coronary thrombolysis, presented by O Kamp (Amsterdam, NL)

Lecture 1: Fundamentals of Molecular Imaging with Contrast Echocardiography
Presented by Prof. Jonathan Lindner from Oregon University, one of the leaders of the research conducted in this field in the last ten years. 

Dr. Lindner started talking about the evolution of molecular imaging technology.  He reported the main fields of interest in cardiology and discussed the main imaging modalities and agents characteristics, with special emphasis in microvascular behavior of microbubbles and the ligand conjugation of microbubbles to facilitate their intravascular retention in targeted-sites.

After this introduction, he focused on two main areas of interest for molecular imaging in cardiology using targeted ultrasound contrast agents: Myocardial ischemic memory and molecular Imaging in atherosclerosis.

Regarding myocardial ischemic memory Imaging, the lecturer nicely showed how in experimental models, P-selection targeted microbubbles may be used as markers of post-ischemia due to preferential retention in the affected microvascular bed.

About molecular imaging in atherosclerosis, Dr. Lindner discussed the potential roles and applications, potential targets and the influence of important factor like high shear stress in arterial models. Finally he dedicated some time to the possibilities of molecular imaging of the immune effects of stem cells.

Lecture 2: Stem cell and gene therapy
This lecture prepared by Dr. Klaus Tiemann from Munich, was presented by Dr. Steven Feinstein, who talked about the potential uses of ultrasound to induce stimulation of engraftment of stem cell into the myocardium after myocardial infarction in experimental models.

It was also shown, based on Dr. Tiemann’s group experience, how is it possible that more stem cells reach more the myocardium after stimulation with high intensity focused ultrasound (HIFU). This finding suggests that focused ultrasound may influence many different steps in stem cell homing, from adherence in target sites to transmigration across the endothelial barrier.

Another part of the presentation was dedicated to gene delivery of plasmids and siRNA into the myocardium, employing sonotransfection, and its therapeutic potentials in animal models of atherosclerotic disease.

Lecture 3: Coronary Sonothrombolysis
In this lecture, Dr. Otto Kamp from UV University Center in Amsterdam presented the first experience of the use of coronary sonothrombolysis in a randomised trial with patients having ST elevation acute Myocardial Infarction.

He explained how sonothrombolysis may provide a low risk method that could facilitate effective recanalisation of thrombosed arteries early before thrombolitics or PCI, and eventually as adjuvants pre-treatment.

Also, in this lecture, Dr. Kamp explained the fundamentals of how the interaction of microbubbles can enhance the effectiveness of thrombolytic agents using both in vitro and in vivo experimental models, and,based in previously described experiences of ultrasound enhanced thrombolysis, in stroke patients.

Finally, he described the current protocol and rationale of Ultrasound enhanced prehospital thrombolysis using microbubbles in patients with ST elevation myocardial infarction (sonolysis study).

A very interesting secondary objective of this trial  commented by Dr. Kamp, is to evaluate the effect of the combination of microbubbles and ultrasound on microvascular no-reflow phenomena after PCI and the bases of potential benefits for protecting from microvascular damage.

Lecture 4: Plaque Vulnerability
This lecture by Dr. Steven Feinstein from Chicago, was aimed at exposing the current status of contrast enhanced ultrasonography (CEUS) in carotid arterial disease and the potential role of contrast and US techniques for the identification and treatment of vulnerable plaques.

Dr. Feinstein started talking about the potential use of microbubbles as potential carriers of therapeutic agents to be delivered in target sites.

Then he focused his lectured on the imaging of carotid plaques remarking the importance of CEUS for screening and for severity assessment based not only in the degree of obstruction caused by the plaque but also in other findings like the presence of neovascularisation and neoangiogenesis.

Neoangiogenesis can be identified by means of CEUS, correlating very nicely to histological findings. In addition demonstration of neovascularisation can be used as a marker of past cardiovascular disease and as a powerful tool for detecting atherosclerotic plaque vulnerability, permitting risk stratification and monitoring of plaque stabilising therapies.




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The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.

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