Contrast for assessment of Left Ventricular structure and function

EACVI Contrast Echocardiography Imaging Box

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

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.

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”

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

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.

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

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