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Contrast echocardiography and tissue harmonic imaging: how to assess


Professor Roxy Senior Professor Roxy Senior

Dr Andreas Hagendorff Dr Andreas Hagendorff

This session provided an overview of contrast echocardiography in clinical cardiology.

The first speaker was Dr Rainer Hoffman, Aachen, Germany who discussed the present day status of contrast echocardiography for the assessment of LV structure and function. It is quite clear that 2D contrast echocardiography remains the technique of choice for reproducible evaluation of LV volumes and LV ejection fraction compared to 3D contrast and cardiac magnetic resonance imaging (CMR). This was shown in a recently concluded multicentre study. Dr Hoffman also reiterated the value of using contrast echocardiography for the assessment of LV structure. The presentation reinforced the recommendations on Contrast Echocardiography issued by the EAE (Senior et al Eur J Echocardiogr 2009;10(2):194-212).
The next speaker was Dr A Salustri, Abu Dhabi, UAE. He discussed the value of assessing myocardial ischemia by Myocardial Contrast Echocardiography (MCE). He showed that meta-analysis demonstrated the superior sensitivity of MCE compared to SPECT and wall motion assessment during stress testing. This is because MCE has superior spatial and temporal resolution compared to SPECT and perfusion abnormalities occur earlier in the ischemic cascade compared to wall motion changes. However, uptake in clinical cardiology is slow, mainly because of reimbursement issues and the apparent complexity of procedure and interpretation. The lack of radiation and a bedside technique makes MCE an attractive alternative.
Dr Hagendorff, Leipzig, Germany gave an overview of the use of contrast echocardiography for evaluation of myocardial viability. He showed that contrast echocardiography improves assessment of wall thickening, while at the same time allowing perfusion assessment of dyssynergic myocardium. Presence of perfusion predicted myocardial viability, while lack of perfusion predicted non-viable myocardium. There was a good correlation with CMR assessment of viable myocardium.
The final talk was by Prof. Senior, London, UK. He showed clinical examples where Contrast Echocardiography with perfusion provided information that allowed the clinician to arrive at a diagnosis in patients with cardiac masses, suspected coronary artery disease, aortic pathology and carotid disease. He also demonstrated its clinical use in the cath lab, where significantly symptomatic patients with non-flow-limiting stenosis demonstrated myocardial ischemia after intracoronary acetylcholine. Acetylcholine may reveal vasospasm and or microcirculatory dysfunction.




Contrast echocardiography and tissue harmonic imaging: how to assess

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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