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Consider that triggered imaging always shows more perfusion(bubbles) in the microcirculation than realtime, due to less bubble destruction | ||
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Triggered and realtime 4-chamber view: apical and mid septal segments show only mildly reduced rest late perfusion, strongly suggestive of residual viability. Note how realtime clips underestimate perfusion compared with triggered imaging | ||
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Viability is absent only in the RCA inferior territory, while LAD territory is clearly mostly viable based on at least partly maintained perfusion at tissue level (microcirculation) in most LAD segments | ||
| The lateral wall in this example is viable, as contrast uptake is seen after flash destruction (implying an intact microcirculation) | The patient went on to have CRT device implanted and follow-up echo showed reduced LV volume (reverse remodelling) with improved ejection fraction |
| This case helps to demonstrate the utility of MCE-derived viability assessment for determining optimal LV lead positioning | |
Tips and Tricks in this case
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| This is a triggered sequence which has been created extracting single frames from a realtime sequence (37Hz) Note how the apical defect, is more pronounced compared with a true triggered sequence (see previous slide) This is due to the relatively high frame rate of realtime imaging which destroys more microbubbles than using a single image per cycle: this may have a signifcant impact when perfusion is already compromised | |||
 | In this case anterolateral basal and mid segments become interpretable by selecting an end-diastolic frame instead of the commonly used end-systolic frames |
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