The clinically applied value of myocardial perfusion and systolic function in patients with coronary artery disease after coronary artery bypass surgery using real-time myocardial contrast echocardiography(RT-MCE) com...The clinically applied value of myocardial perfusion and systolic function in patients with coronary artery disease after coronary artery bypass surgery using real-time myocardial contrast echocardiography(RT-MCE) combined with two-dimensional strain echocardiography was assessed.Twenty patients underwent intravenous RT-MCE by intravenous injections of SonoVue before and after coronary artery bypass surgery.Two-dimensional images were recorded from the left ventricular four-chamber view,two-chamber view and the apical view before,and two weeks and three months after coronary artery bypass surgery,and the peak systolic longitudinal strain was measured.The results showed that myocardial perfusion was significantly increased after coronary artery bypass surgery in about 71.6% segments.In the group that myocardial perfusion was improved,the peak systolic longitudinal strain three months after bypass surgery was significantly higher than that before operation [(-15.78±5.91)% vs(-10.45±8.31)%,P<0.05].However,the parameters did not change in the group without myocardial perfusion improvement [(-10.33±6.53)% vs(-9.41±6.09)%,P>0.05].It was con-cluded that whether or not the improvement of myocardial perfusion can mirror the recovery trend of regional systolic function,two-dimensional strain echocardiography can observe dynamic change of regional systolic function.The combination of myocardial perfusion with two-dimensional strain echocar-diography can more accurately assess the curative effectiveness of coronary artery bypass surgery.展开更多
Objective To evaluate the feasibility and accuracy of measurement of myocardial perfusion defects with intravenous contrast-enhanced real-time three-dimensional echocardiography (CE-RT3DE). Methods RT3DE was performed...Objective To evaluate the feasibility and accuracy of measurement of myocardial perfusion defects with intravenous contrast-enhanced real-time three-dimensional echocardiography (CE-RT3DE). Methods RT3DE was performed in 21 open-chest mongrel dogs undergoing acute ligation of the left anterior descending artery (LAD, n=14) or distal branch of the left circumflex artery (LCX, n=7). A perfluorocarbon microbubble contrast agent was injected intravenously to assess the resulting myocardial perfusion defects with Philips Sonos-7500 ultrasound system. Evans blue dye was injected into the occluded coronary artery for subsequent anatomic identification of underperfused myocardium. In vitro anatomic measurement of myocardial mass after removal of the animal’s heart was regarded as the control. Blinded off-line calculation of left ventricular mass and perfusion defect mass from RT3DE images were performed using an interactive aided-manual tracing technique.Results Total left ventricular (LV) myocardial mass ranged from 38.9 to 78.5 (mean±SD: 60.0±10.1) g. The mass of perfusion defect ranged from 0 to 21.4 (mean±SD: 12.0±5.0) g or 0 to 27% of total LV mass (mean±SD: 19%±6%). The RT3DE estimation of total LV mass (mean±SD: 59.8±9.9 g) strongly correlated with the anatomic measurement (r=0.98; y=2.01+0.96x). The CE-RT3DE calculation of the mass of underperfused myocardium (mean±SD: 12.3±5.3 g) also strongly correlated with the anatomic measurement (r=0.96; y=-0.10+1.04x) and when expressed as percentage of total LV mass (r=0.95; y=-0.20+1.04x). Conclusions RT3DE with myocardial contrast opacification could accurately estimate underperfused myocardial mass in dogs of acute coronary occlusion and would play an important role in quantitative assessment of myocardial perfusion defects in patients with coronary artery disease.展开更多
In order to evaluate the left ventricular remodeling in patients with myocardial infarction after revascularization with intravenous real-time myocardial contrast echocardiography(RT-MCE),intravenous RT-MCE was perfor...In order to evaluate the left ventricular remodeling in patients with myocardial infarction after revascularization with intravenous real-time myocardial contrast echocardiography(RT-MCE),intravenous RT-MCE was performed on 20 patients with myocardial infarction before coronary revascularization.Follow-up echocardiography was performed 3 months after coronary revascularization.Segmental wall motion was assessed using 18-segment LV model and classified as normal,hypokinesis,akinesis and dyskinesis.Myocardial perfusion was assessed by visual interpretation and divided into 3 conditions:homogeneous opacification=1;partial or reduced opaciflcation or suben-docardial contrast defect=2;constrast defect=3.Myocardial perfusion score index(MPSI) was calculated by dividing the total sum of contrast score by the total number of segments with abnormal wall motion.Twenty patients were classified into 2 groups according to the MPSI:MPSI≤1.5 as good myocardial perfusion,MPSI>1.5 as poor myocardial perfusion.To assess the left ventricular remodeling,the following comparisons were carried out:(1) Comparisons of left ventricular ejection fraction(LVEF),left ventricular end-systolic volume(LVESV) and left ventricular end-diastolic volume(LVEDV) before and 3 months after revascularization in two groups;(2) Comparisons of LVEF,LVESV and LVEDV prerevascularization between two groups and comparisons of these 3 months post-revascularization between two groups;(3) Comparisons of the differences in LVEF,LVESV and LVEDV between 3 months post-and pre-revascularization(△LVEF,△LVESV and △LVEDV) between two groups;(4) The linear regression analysis between △LVEF,△LVESV,△LVEDV and MPSI.The results showed that the LVEF obtained 3 months after revascularization in patients with MPSI>1.5 was obviously lower than that in those with MPSI≤1.5.The LVEDV obtained 3 months post-revascularization in patients with MPSI>1.5 was obviously larger than that in those with MPSI≤1.5(P=0.002 and 0.04).The differences in △LVEF and △LVEDV between patients with MPSI>1.5 and those with MPSI≤1.5 were significant(P=0.002 and 0.001,respectively).Linear regression analysis revealed that MPSI had a negative correlation with △LVEF and a positive correlation with △LVESV,△LVEDV(P=0.004,0.008,and 0.016,respectively).It was concluded that RT-MCE could accurately evaluate the left ventricular remodeling in patients with myocardial infarction after revascularization.展开更多
To evaluate the feasibility of real-time myocardial contrast echocardiography (RTMCE) by quantitative analysis of myocardial perfusion in rabbits, transthoracic RTMCE was performed in 10 healthy rabbits by using conti...To evaluate the feasibility of real-time myocardial contrast echocardiography (RTMCE) by quantitative analysis of myocardial perfusion in rabbits, transthoracic RTMCE was performed in 10 healthy rabbits by using continuous infusion of SonoVue into the auricular vein. The short axis view at the papillary muscle level was obtained. The duration of the time that the contrast took to appear in right heart, left heart and myocardium was recorded. The regional myocardial signal intensity (SI) versus re-filling time plots were fitted to an exponential function: y(t) =A(1–e–β(t–t0)) + C, where y is SI at any given time, A is the SI plateau that reflects myocardial blood volume, and β is the slope of the refilling curve that reflects myocardial microbubble velocity. The A, β and A×β values at different infusion rate of SonoVue were analyzed and the A, β and A×β values in each segment in the short axis view at the papillary muscle level were compared. All the animal experiments were successful and high-quality im-ages were obtained. The best intravenous infusion rate for SonoVue was 30 mL/h. The contrast appeared in right heart, left heart and myocardium at 7.5±2.2 s, 9.1±2.4 s and 12.2±1.6 s respectively. After 16.6±2.3s, myocardial opacification reached a steady state. The mean A, β and A×β value in the short axis view at the papillary muscle level were 9.8±3.0 dB, 1.4±0.5 s-1 and 13.5±3.6 dB×s-1 respectively. A, β and A×β values showed no significant differences among 6 segments. It was suggested that RTMCE was feasible for quantitative analysis of myocardial perfusion in rabbits. It provides a non-invasive method to evaluate the myocardial perfusion in rabbit disease models.展开更多
Background Myocardial blood flow(MBF) can be quantified with myocardial contrast echocardiography (MCE) during a venous infusion of microbubble. A minimal MBF is required to maintain cell membrane integrity and myocar...Background Myocardial blood flow(MBF) can be quantified with myocardial contrast echocardiography (MCE) during a venous infusion of microbubble. A minimal MBF is required to maintain cell membrane integrity and myocardial viability in ischemic condition. Thus, we hypothesized that MCE could be used to assess myocardial viability by the determination of MBF. Methods and ResultsMCE was performed at 4 hours after ligation of proximal left anterior descending coronary artery in 7 dogs with constant venous infusions of microbubbles. The video intensity versus pulsing interval plots derived from each myocardial pixel were fitted to an exponential function: y=A(1-e-βt), where y is Ⅵ at pulsing interval t, A reflects microvascular cross - sectional area (or myocardial blood volume), and (3 reflects mean myocardial microbubble velocity. The product of A·β represents MBF. MBF was also obtained by ra-diolabeled microsphere method servered as reference. MBF derived by radiolabeled microsphere - method in the展开更多
The myocardial viability after myocardial infarction was evaluated by intravenous myocardial contrast echocardiography.Intravenous real-time myocardial contrast echocardiography was performed on 18 patients with myoca...The myocardial viability after myocardial infarction was evaluated by intravenous myocardial contrast echocardiography.Intravenous real-time myocardial contrast echocardiography was performed on 18 patients with myocardial infarction before coronary revascularization.Follow-up echocardiography was performed 3 months after coronary revascularization.Segmental wall motion was assessed using 18-segment LV model and classified as normal,hypokinesis,akinesis and dyskinesis.Viable myocardium was defined by evident improvement of segmental wall motion 3 months after coronary revascularization.Myocardial perfusion was assessed by visual interpretation and divided into 3 conditions:homogeneous opacification;partial or reduced opaciflcation or subendocardial contrast defect;contrast defect.The former two conditions were used as the standard to define the viable myocardium.The results showed that 109 abnormal wall motion segments were detected among 18 patients with myocardial infarction,including 47 segments of hypokinesis,56 segments of akinesis and 6 segments of dyskinesis.The wall motion of 2 segments with hypokinesis before coronary revascularization which showed homogeneous opacification,14 of 24 segments with hypokinese and 20 of 24 segments with akinese before coronary revascularization which showed partial or reduced opaciflcation or subendocardial contrast defect was improved 3 months after coronary revascularization.In our study,the sensitivity and specificity of evaluation of myocardial viability after myocardial infarction by intravenous real-time myocardial contrast echocardiography were 94.7% and 78.9%,respectively.It was concluded that intravenous real-time myocardial contrast echocardiography could accurately evaluate myocardial viability after myocardial infarction.展开更多
Here, a patient with chest pain and <50% stenosis on coronary angiography, where ATP stress myocardial contrast echocardiography (MCE) revealed that coronary flow reserve was reduced to 1.71 was presented. Perfusio...Here, a patient with chest pain and <50% stenosis on coronary angiography, where ATP stress myocardial contrast echocardiography (MCE) revealed that coronary flow reserve was reduced to 1.71 was presented. Perfusion delay occurred in the left ventricular wall of the apex of the heart before ATP stress, and the perfusion delay area was significantly reduced at peak stress. Similar to the characteristics of "reverse redistribution" of radionuclide myocardium perfusion in coronary vasospasm, the delayed perfusion area in the recovery period was larger than that detected before stress. Together with increased spectral resistance of the distal segment of left anterior descending coronary artery and chest pain, these findings indicated coronary microvascular disease with spasmodic characteristics in this patient. The perfusion characteristics on ATP stress determined by MCE and changes in coronary spectrum have value for the diagnosis and treatment of coronary microvascular disease with spasmodic characteristics.展开更多
Background Both real-time three-dimensional echocardi ography (RT3DE) and myocardial contrast echocardiography (MCE) are novel imaging techniques. The purpose of this study was to confirm the feasibility and accuracy ...Background Both real-time three-dimensional echocardi ography (RT3DE) and myocardial contrast echocardiography (MCE) are novel imaging techniques. The purpose of this study was to confirm the feasibility and accuracy of RT3DE combined with MCE for quantitative evaluation of myocardial perfusion defects. Methods Thirteen dogs underwent ligation of the left anterior descending artery (LAD, n=6) or distal branch of the left circumflex artery (LCX, n=7) under general anaesthesia. Three to four ml of a perfluoropropane (C 3F 8) microbubble contrast agent was injected intravenously to assess the resulting myocardial perfusion defects with a commercially available Philips SONOS-7500 ultrasound system. After removal of the dog hearts, Evans blue dye was injected via the left and righ t coronary arteries to stain the myocardium at risk. In vitro anatomic measurements of myocardial mass after removal of the animals’ hearts were used as control s. Results Left ventricular (LV) mass determined by RT3DE ranged 36.7-68.9 g [mean, (54.6±9.6) g] before coronary artery ligation, and correlated highly (r=0.99) with in vitro measurement of LV mass [range, 38.9-71.1 g; mean, (55.6±9.3) g]. There was no significant difference between RT3DE and in vitro measurements of LV mass [range, 36.7-68.9 g; mean, (51.3±12.5) g. Or range, 38.9-71. 1 g; mean, (53.7±12.3) g, respectively] and under-perfused mass [range, 0-21.4 g; mean, (12.0±6.9) g. Or range, 0-19.8 g; mean, (10.8±6.3) g, respectively] after th e LAD ligation (P>0.05). Likewise, no significant difference was present between RT3DE and in vitro measurements of LV mass [range, 50.1-65.4 g; mean, (57.5±5.9 ) g. Or range, 51.5-65.8 g; mean, (57.3±6.4) g, respectively] and under-perfused m ass [range, 0-25.6 g; mean, (13.3±9.6) g. Or range, 0-22.7 g; mean, (12.8±8.1 ) g, respectively] after the LCX ligation (P>0.05). For all the animals with coronary ligation, LV mass measured by RT3DE ranged 35.9-68.6 g [mean, (54.8±10.0) g] a nd there was no significant difference between RT3DE and in vitro measurements of LV mass and under-perfused mass (P>0.05, r=0.99). Further, the under-perfused mass derived from RT3DE [range, 0-25.6 g; mean, (12.7±8.2) g] correlate d strongly with the in vitro measurements [range, 0-22.7 g; mean, (11.9±7.2) g] ( r=0.96). Conclusion RT3DE with MCE is a rapid and accurate method for estimating LV myocardial mass and quantifying perfusion defects.展开更多
Background Quantitatively assessing myocardial perfusion and its reserve is of great importance for the diagnosis and stratification of patients with coronary artery disease (CAD), and represents an important goal of ...Background Quantitatively assessing myocardial perfusion and its reserve is of great importance for the diagnosis and stratification of patients with coronary artery disease (CAD), and represents an important goal of myocardial contrast echocardiography. In this study we sought to test the usefulness of low dose dobutamine stress real-time myocardial contrast echocardiography (RT-MCE) in the assessment of CAD, and to explore the relationship between perfusion reserve and contractile reserve.Methods Twenty-six patients with suspected or clinical diagnosed CAD were enrolled and underwent RT-MCE at baseline and under low dose dobutamine stress, and subsequent coronary angiography. RT-MCE images were analyzed quantitatively from microbubble replenishment curves for myocardial perfusion and its reserve. Results At baseline, significant differences in beta (0.28±0.12, 0.25±0.09, 0.22±0.06, 0.20±0.07 respectively, P<0.01) and A×beta (1.37±0.46, 1.28±0.47, 1.13±0.37, 0.91±0.32, respectively, P<0.01) were observed among four segment groups with graded coronary artery stenosis severity (normal; 30%-69% stenosis; 70%-90% stenosis; and beyond 90% stenosis), but not observed in parameter A. When under stress, significant differences in A (5.73±1.28, 5.63±1.01, 4.96±0.81, 4.57±0.62, respectively, P<0.01), beta (0.67±0.17, 0.55±0.19, 0.32±0.13, 0.25±0.08, respectively, P<0.01) and A×beta (3.81±1.20, 3.11±1.17, 1.59±0.82, 1.12±0.37, respectively, P<0.01) were observed among the formerly mentioned groups. Graded decreases in A reserve (1.20±0.53, 1.11±0.16, 0.98±0.12, 0.99±0.13, respectively, P<0.01), beta reserve (2.65±1.07, 2.32±0.82, 1.44±0.40, 1.29±0.34,respectively, P<0.01) and A×beta reserve (3.05±1.63, 2.59±1.01, 1.42±0.44, 1.27±0.34, respectively, P<0.01) could also be observed with increasing coronary stenosis severity. In five segments groups scored by WMS (1-5), concordance between contractile function and myocardial perfusion could be found both at rest (beta: 0.28±0.11, 0.22±0.08, 0.21±0.05, 0.17±0.05, 0.19±0.06, respectively, P<0.01; A×beta: 1.29±0.48, 0.98±0.45, 0.94±0.29, 0.76±0.30, 0.92±0.32, respectively, P<0.01) and under stress (beta: 0.59±0.20, 0.35±0.15, 0.27±0.08, 0.17±0.05, 0.20±0.05, respectively, P<0.01; A×beta: 3.07±1.38, 1.62±0.82, 1.28±0.40, 0.78±0.24, 0.93±0.22, respectively, P<0.01). This concordance is also valid in terms of the reserves, and the MCE parameters in segments with ameliorated contractile function are significantly higher than in those without. Conclusions Quantitative RT-MCE in conjunction with dobutamine stress shows promise in identifying and stratifying CAD and in exploring the perfusion-contractile correlation.展开更多
Detection of abnormal myocardial perfusion is crucial to the prognosis of patients with coronary artery disease(CAD)after they have undergone percutaneous coronary intervention(PCI).The objective of this study is to e...Detection of abnormal myocardial perfusion is crucial to the prognosis of patients with coronary artery disease(CAD)after they have undergone percutaneous coronary intervention(PCI).The objective of this study is to evaluate the effect of myocardial perfusion by three different methods—intra-coronary myocardial contrast echocardiography(ICMCE),corrected thrombolysis in myocardial infarction frame count(CTFC),and coronary blood flow velocity(BFV)—and to determine the value of these different methods in the evaluation of the effect of myocardial perfusion post-PCI.For the study sixty-eight patients were divided into four groups based on selective coronary angiography results:group A(normal coronary artery),group B(75%–95%coronary artery stenosis),group C(coronary artery stenosis>95%)and group D(acute total coronary occlusion).The effect of myocardial reperfusion was evaluated using the above mentioned three methods 15 min after PCI.IC-MCE was also performed before PCI in group D.The quantitative parameters of MCE involved:contrast peak intensity,time to peak intensity and area under the curve,representing myocardial blood volume,reperfusion velocity and myocardial blood flow,respectively.No difference was found in CTFC between the coronary artery stenosis group and the normal group.BFV was slower in group D than in group A(P<0.05).The myocardial blood volume and the myocardial blood flow of the IC-MCE quantitative parameters were markedly lower in group C compared with those in group A(P<0.05),and there were significant differences in the three MCE parameters between group D and group A(P<0.05).For those patients with acute or total occlusion,the levels of myocardial perfusion before and after PCI were similar,as determined by IC-MCE and visually analyzed from 61 segments(P<0.05).Quantitative IC-MCE evaluation of myocardial reperfusion is more accurate than with the other two methods.Moreover,with qualitative IC-MCE the level of myocardial reperfusion can be viewed directly and rapidly.Thus,the IC-MCE method is of great value to coronary artery disease(CAD)patients undergoing PCI,especially for those with acute myocardial infarction(AMI).展开更多
Background Time-intensity curves derived from microbubble destruction/refilling sequences and recorded using myocardial contrast echocardiography （MCE） can provide parameters that correlate with coronary blood flow....Background Time-intensity curves derived from microbubble destruction/refilling sequences and recorded using myocardial contrast echocardiography （MCE） can provide parameters that correlate with coronary blood flow. The response of these parameters to adenosine vasodilatation correlates with coronary flow reserve （CFR） measured by fluorescent microsphere techniques （FMT）. Currently, no data exist regarding the effect of physiological variables, such as hypoxia, on the determination of CFR by MCE. The purpose of this study was to define the effects of decreases in blood partial pressure of oxygen （PO2） on CFR as measured by MCE. Methods Studies were performed in 9 closed chest swine. Low-energy, real-time MCE was performed with commercial instruments in short axis view at papillary muscle level while infusing BR1 at 30 ml/h. High-energy ultrasound bursts （referred to as FLASH frames） destroyed the bubbles every 15 cardiac cycles, and resultant time-intensity curves derived from these sequences were fitted to the exponential function y = A （1-e -bt） +c, from which the rate of signal rise （b） was obtained. CFR was calculated as the ratio of b values after adenosine infusion to baseline and was obtained during the control period and after decreasing blood PO2 by giving nitrogen via a respirator to create artificial hypoxic conditions. CFR was independently determined by FMT. Results Nitrogen led to significant decreases in mean PO2, from （120.6±18.9） mmHg to （51.8±15.9） mmHg （P<0.01）. Adenosine produced a similar increase in CFR （2.5 fold vs 3.1 fold） as assessed by MCE and FMT during the control period. The decrease in PO2 post nitrogen resulted in a slight increase in values at rest: 0.46±0.15 to 0.53±0.18 for b and （1.39±0.66） ml·min -1·g -1 to （1.72±0.30） ml·min -1·g -1 for myocardial blood flow （MBF） （both P<0.05）. In addition, values decreased in response to adenosine using both techniques: 1.05±0.35 to 0.82±0.27 for b and （4.30±3.16） ml·min -1·g -1 to （3.93±1.27） ml·min -1·g -1 for MBF （both P<0.05）. Thus, CFR was markedly reduced under hypoxic conditions, to 1.4 by MCE （P<0.05 compared with the baseline）, and to 2.5 by FMT （P>05 compared with the baseline）. Conclusions CFR values diminish under hypoxic conditions according to both MCE and FMT. The reductions in CFR involve both an increase in resting values and a decrease in post adenosine measurements, as determined by both techniques. The reduction in CFR under hypoxia is slightly greater using MCE than using FMT. Physiological variables, such as hypoxia, must be taken into consideration when assessing CFR by MCE.展开更多
Our understanding of coronary syndromes has evolved in the last two decades out of the obstructive atherosclerosis of epicardial coronary arteries paradigm to include anatomo-functional abnormalities of coronary micro...Our understanding of coronary syndromes has evolved in the last two decades out of the obstructive atherosclerosis of epicardial coronary arteries paradigm to include anatomo-functional abnormalities of coronary microcirculation. No current diagnostic technique allows direct visualization of coronary microcirculation,but functional assessments of this circulation are possible. This represents a challenge in cardiology. Myocardial contrast echocardiography(MCE) was a breakthrough in echocardiography several years ago that claimed the capability to detect myocardial perfusion abnormalities and quantify coronary blood flow. Research demonstrated that the integration of quantitative MCE and fractional flow reserve improved the definition of ischemic burden and the relative contribution of collaterals in non-critical coronary stenosis. MCE identified no-reflow and low-flow within and around myocardial infarction,respectively,and predicted the potential functional recovery of stunned myocardium using appropriate interventions. MCE exhibited diagnostic performances that were comparable to positron emission tomography in microvascular reserve and microvascular dysfunction in angina patients. Overall,MCE improved echocardiographic evaluations of ischemic heart disease in daily clinical practice,but the approval of regulatory authorities is lacking.展开更多
Echocardiography is the most common diagnostic method for assessing cardiac function but some limitations affect this technique.Until now,visual assessment of wall motion and thickening has allowed only a subjective e...Echocardiography is the most common diagnostic method for assessing cardiac function but some limitations affect this technique.Until now,visual assessment of wall motion and thickening has allowed only a subjective evaluation of myocardial function and requires long-term training.Recently,new echocardiographic techniques have been introduced to evaluate myocardial mechanics.Tissue Doppler imaging(TDI)technique is limited by angle-dependency such that only deformation along the ultrasound beam can be derived from velocities,while myocardium deforms simultaneously in three dimensions.Speckle tracking echocardiography (STE)is a more recent technique that provides a global approach to left ventricular myocardial mechanics,giving information about the three spatial dimensions of cardiac deformation.In this editorial,we describe the physical and pathophysiological concepts of STE,discussing the differences compared to TDI and underlining the pitfalls of this new technique.展开更多
BACKGROUND Endocardial fibroelastosis(EFE)is a rare heart disease characterized by thickening of the endocardium caused by massive proliferation of collagenous and elastic tissue,usually leading to impaired cardiac fu...BACKGROUND Endocardial fibroelastosis(EFE)is a rare heart disease characterized by thickening of the endocardium caused by massive proliferation of collagenous and elastic tissue,usually leading to impaired cardiac function.Multimodality cardiovascular imaging for the evaluation of EFE with thrombi is even rarer.CASE SUMMARY We report a rare case of EFE associated with multiple cardiovascular thrombi.Three-dimensional(3D)and contrast echocardiography(CE)were used to assess ventricular thrombi.Anticoagulant therapy was administered to eliminate the thrombi.The peripheral contrast-enhanced thrombi with the highest risk were dissolved with anticoagulant therapy at the time of reexamination,which was consistent with the presumption of fresh loose thrombi.CONCLUSION This new echocardiography technique has a great advantage in the diagnosis and treatment of EFE.On the basis of conventional echocardiography,3D echocardiography is used to display the position,shape,and narrow base of the thrombus.CE does not only help to confirm the diagnosis of thrombus,but also determines its risk.展开更多
BACKGROUND Increasing reports have demonstrated that recombinant human brain natriuretic peptide(rhBNP)can improve acute myocardial infarction(AMI)and heart failure.However,whether it can improve renal function and de...BACKGROUND Increasing reports have demonstrated that recombinant human brain natriuretic peptide(rhBNP)can improve acute myocardial infarction(AMI)and heart failure.However,whether it can improve renal function and decrease the risk of contrastinduced nephropathy(CIN)in elderly AMI patients is still unclear.AIM To explore the effect of rhBNP on CIN in elderly AMI patients after percutaneous coronary intervention(PCI).METHODS One hundred and thirty-one elderly AMI patients underwent PCI from January 2017 to July 2021.Patients were either given 1 mL of 0.9%normal saline/(kg/h)for 72 h after PCI(control group,n=66)and or intravenous rhBNP[1.5 mg/kg followed by 0.0075 mg/(kg/min)]for 72 h(rhBNP treatment group,n=65).Serum creatinine and cystatin C levels,creatinine clearance rate,and eGFR were measured at 24 h,48 h,and 72 h after PCI.Research nurses collected data on hand-written forms,and then stored them in password-protected electronic databases.RESULTS The creatinine clearance rate and eGFR were increased,while the creatinine and cystatin C levels were decreased significantly in the rhBNP treatment group compared to the control group at 48 h and 72 h.The incidence of CIN(P=0.028)and acute heart failure(P=0.017)also significantly decreased in the rhBNP group.No significant difference was noted between the two groups in cardiac death and recurrent AMI.CONCLUSION Early application of rhBNP could protect renal function and decrease the incidence of CIN after primary PCI and acute heart failure.展开更多
Purpose: The aim of the present study was to evaluate the diagnostic accuracy for quantification of left ventricular (LV) volumes and LV ejection fraction (LVEF) with current echocardiographic methods of planimetry fo...Purpose: The aim of the present study was to evaluate the diagnostic accuracy for quantification of left ventricular (LV) volumes and LV ejection fraction (LVEF) with current echocardiographic methods of planimetry for analysis of LV remodeling after myocardial infarction in daily clinical routine. Methods: 26 patients were investigated directly after interventional therapy at hospital pre-discharge and at 6 month follow-up. Standardized 2D transthoracic native and contrast echocardiography were performed in all patients. Due to methodological aspects the results of LV volumes and LVEF using native echocardiography were compared to the results of LV opacification (LVO) imaging for analysis in mono-, bi- and triplane data sets using the Simpson’s rule. In addition corresponding multidimensional data sets were analyzed. Results: The assessment of LV volumes and LVEF is more accurate with contrast echocardiography. The comparison of LV volumes and LVEF shows significant increases using contrast echocardiography (p < 0.001). Larger left ventricular end-diastolic volumes (LVEDV) are measured at follow up (p < 0.05). Significant differences (p < 0.001) are found for the determination of LVEDV and LVEF relating to apical mono-, bi-, tri- and multiplane data sets. Standard deviations of the triplane approach, however, are significantly lower than using other modalities. Conclusion: Depending on the localization of the myocardial infarction LV volumes and LVEF are less reliably evaluated using the mono- or biplane approach. According to standardization and simultaneous acquisition of all LV wall segments the triplane approach is currently the best approach to determine LV systolic function. In addition, contrast echocardiography is indicated to improve endocardial border delineation in patients using the triplane or multiplane approach. To our knowledge the present study is the first systematic evaluation of all current possibilities for determination of LV volumes and LVEF by native and contrast echocardiography.展开更多
BACKGROUND As an established,simple,inexpensive,and surprisingly effective diagnostic tool,right-heart contrast echocardiography(RHCE)might help in solving a vexing diagnostic problem.If performed appropriately and in...BACKGROUND As an established,simple,inexpensive,and surprisingly effective diagnostic tool,right-heart contrast echocardiography(RHCE)might help in solving a vexing diagnostic problem.If performed appropriately and interpreted logically,RHCE allows for differentiation of various usual and unusual right-to-left shunts based on the site of injection and the sequence of microbubble appearance in the heart.CASE SUMMARY A 31-year-old woman was readmitted to hospital with a 2-mo history of worsening palpitation and chest distress.Two years prior,she had been diagnosed with postpartum pulmonary embolism by conventional echocardiography and computed tomography angiography.While the latter showed no sign of pulmonary artery embolism,the former showed pulmonary artery hypertension,moderate insufficiency,and mild stenosis of the aortic valve.RHCE showed microbubbles appearing in the left ventricle,slightly delayed after rightheart filling with microbubbles;no microbubbles appeared in the left atrium and microbubbles’appearance in the descending aorta occurred nearly simultaneous to right pulmonary artery filling with microbubbles.Conventional echocardiography was re-performed,and an arterial horizontal bidirectional shunt was found according to Doppler enhancement effects caused by microbubbles.The original computed tomography angiography findings were reviewed and found to show a patent ductus arteriosus.CONCLUSION RHCE shows a special imaging sequence for unexplained pulmonary artery hypertension with aortic valve insufficiency and simultaneous patent ductus arteriosus.展开更多
文摘The clinically applied value of myocardial perfusion and systolic function in patients with coronary artery disease after coronary artery bypass surgery using real-time myocardial contrast echocardiography(RT-MCE) combined with two-dimensional strain echocardiography was assessed.Twenty patients underwent intravenous RT-MCE by intravenous injections of SonoVue before and after coronary artery bypass surgery.Two-dimensional images were recorded from the left ventricular four-chamber view,two-chamber view and the apical view before,and two weeks and three months after coronary artery bypass surgery,and the peak systolic longitudinal strain was measured.The results showed that myocardial perfusion was significantly increased after coronary artery bypass surgery in about 71.6% segments.In the group that myocardial perfusion was improved,the peak systolic longitudinal strain three months after bypass surgery was significantly higher than that before operation [(-15.78±5.91)% vs(-10.45±8.31)%,P<0.05].However,the parameters did not change in the group without myocardial perfusion improvement [(-10.33±6.53)% vs(-9.41±6.09)%,P>0.05].It was con-cluded that whether or not the improvement of myocardial perfusion can mirror the recovery trend of regional systolic function,two-dimensional strain echocardiography can observe dynamic change of regional systolic function.The combination of myocardial perfusion with two-dimensional strain echocar-diography can more accurately assess the curative effectiveness of coronary artery bypass surgery.
文摘Objective To evaluate the feasibility and accuracy of measurement of myocardial perfusion defects with intravenous contrast-enhanced real-time three-dimensional echocardiography (CE-RT3DE). Methods RT3DE was performed in 21 open-chest mongrel dogs undergoing acute ligation of the left anterior descending artery (LAD, n=14) or distal branch of the left circumflex artery (LCX, n=7). A perfluorocarbon microbubble contrast agent was injected intravenously to assess the resulting myocardial perfusion defects with Philips Sonos-7500 ultrasound system. Evans blue dye was injected into the occluded coronary artery for subsequent anatomic identification of underperfused myocardium. In vitro anatomic measurement of myocardial mass after removal of the animal’s heart was regarded as the control. Blinded off-line calculation of left ventricular mass and perfusion defect mass from RT3DE images were performed using an interactive aided-manual tracing technique.Results Total left ventricular (LV) myocardial mass ranged from 38.9 to 78.5 (mean±SD: 60.0±10.1) g. The mass of perfusion defect ranged from 0 to 21.4 (mean±SD: 12.0±5.0) g or 0 to 27% of total LV mass (mean±SD: 19%±6%). The RT3DE estimation of total LV mass (mean±SD: 59.8±9.9 g) strongly correlated with the anatomic measurement (r=0.98; y=2.01+0.96x). The CE-RT3DE calculation of the mass of underperfused myocardium (mean±SD: 12.3±5.3 g) also strongly correlated with the anatomic measurement (r=0.96; y=-0.10+1.04x) and when expressed as percentage of total LV mass (r=0.95; y=-0.20+1.04x). Conclusions RT3DE with myocardial contrast opacification could accurately estimate underperfused myocardial mass in dogs of acute coronary occlusion and would play an important role in quantitative assessment of myocardial perfusion defects in patients with coronary artery disease.
文摘In order to evaluate the left ventricular remodeling in patients with myocardial infarction after revascularization with intravenous real-time myocardial contrast echocardiography(RT-MCE),intravenous RT-MCE was performed on 20 patients with myocardial infarction before coronary revascularization.Follow-up echocardiography was performed 3 months after coronary revascularization.Segmental wall motion was assessed using 18-segment LV model and classified as normal,hypokinesis,akinesis and dyskinesis.Myocardial perfusion was assessed by visual interpretation and divided into 3 conditions:homogeneous opacification=1;partial or reduced opaciflcation or suben-docardial contrast defect=2;constrast defect=3.Myocardial perfusion score index(MPSI) was calculated by dividing the total sum of contrast score by the total number of segments with abnormal wall motion.Twenty patients were classified into 2 groups according to the MPSI:MPSI≤1.5 as good myocardial perfusion,MPSI>1.5 as poor myocardial perfusion.To assess the left ventricular remodeling,the following comparisons were carried out:(1) Comparisons of left ventricular ejection fraction(LVEF),left ventricular end-systolic volume(LVESV) and left ventricular end-diastolic volume(LVEDV) before and 3 months after revascularization in two groups;(2) Comparisons of LVEF,LVESV and LVEDV prerevascularization between two groups and comparisons of these 3 months post-revascularization between two groups;(3) Comparisons of the differences in LVEF,LVESV and LVEDV between 3 months post-and pre-revascularization(△LVEF,△LVESV and △LVEDV) between two groups;(4) The linear regression analysis between △LVEF,△LVESV,△LVEDV and MPSI.The results showed that the LVEF obtained 3 months after revascularization in patients with MPSI>1.5 was obviously lower than that in those with MPSI≤1.5.The LVEDV obtained 3 months post-revascularization in patients with MPSI>1.5 was obviously larger than that in those with MPSI≤1.5(P=0.002 and 0.04).The differences in △LVEF and △LVEDV between patients with MPSI>1.5 and those with MPSI≤1.5 were significant(P=0.002 and 0.001,respectively).Linear regression analysis revealed that MPSI had a negative correlation with △LVEF and a positive correlation with △LVESV,△LVEDV(P=0.004,0.008,and 0.016,respectively).It was concluded that RT-MCE could accurately evaluate the left ventricular remodeling in patients with myocardial infarction after revascularization.
文摘To evaluate the feasibility of real-time myocardial contrast echocardiography (RTMCE) by quantitative analysis of myocardial perfusion in rabbits, transthoracic RTMCE was performed in 10 healthy rabbits by using continuous infusion of SonoVue into the auricular vein. The short axis view at the papillary muscle level was obtained. The duration of the time that the contrast took to appear in right heart, left heart and myocardium was recorded. The regional myocardial signal intensity (SI) versus re-filling time plots were fitted to an exponential function: y(t) =A(1–e–β(t–t0)) + C, where y is SI at any given time, A is the SI plateau that reflects myocardial blood volume, and β is the slope of the refilling curve that reflects myocardial microbubble velocity. The A, β and A×β values at different infusion rate of SonoVue were analyzed and the A, β and A×β values in each segment in the short axis view at the papillary muscle level were compared. All the animal experiments were successful and high-quality im-ages were obtained. The best intravenous infusion rate for SonoVue was 30 mL/h. The contrast appeared in right heart, left heart and myocardium at 7.5±2.2 s, 9.1±2.4 s and 12.2±1.6 s respectively. After 16.6±2.3s, myocardial opacification reached a steady state. The mean A, β and A×β value in the short axis view at the papillary muscle level were 9.8±3.0 dB, 1.4±0.5 s-1 and 13.5±3.6 dB×s-1 respectively. A, β and A×β values showed no significant differences among 6 segments. It was suggested that RTMCE was feasible for quantitative analysis of myocardial perfusion in rabbits. It provides a non-invasive method to evaluate the myocardial perfusion in rabbit disease models.
基金This work was supported in part by grants from thescience and technology foundation of China(39870329).
文摘Background Myocardial blood flow(MBF) can be quantified with myocardial contrast echocardiography (MCE) during a venous infusion of microbubble. A minimal MBF is required to maintain cell membrane integrity and myocardial viability in ischemic condition. Thus, we hypothesized that MCE could be used to assess myocardial viability by the determination of MBF. Methods and ResultsMCE was performed at 4 hours after ligation of proximal left anterior descending coronary artery in 7 dogs with constant venous infusions of microbubbles. The video intensity versus pulsing interval plots derived from each myocardial pixel were fitted to an exponential function: y=A(1-e-βt), where y is Ⅵ at pulsing interval t, A reflects microvascular cross - sectional area (or myocardial blood volume), and (3 reflects mean myocardial microbubble velocity. The product of A·β represents MBF. MBF was also obtained by ra-diolabeled microsphere method servered as reference. MBF derived by radiolabeled microsphere - method in the
文摘The myocardial viability after myocardial infarction was evaluated by intravenous myocardial contrast echocardiography.Intravenous real-time myocardial contrast echocardiography was performed on 18 patients with myocardial infarction before coronary revascularization.Follow-up echocardiography was performed 3 months after coronary revascularization.Segmental wall motion was assessed using 18-segment LV model and classified as normal,hypokinesis,akinesis and dyskinesis.Viable myocardium was defined by evident improvement of segmental wall motion 3 months after coronary revascularization.Myocardial perfusion was assessed by visual interpretation and divided into 3 conditions:homogeneous opacification;partial or reduced opaciflcation or subendocardial contrast defect;contrast defect.The former two conditions were used as the standard to define the viable myocardium.The results showed that 109 abnormal wall motion segments were detected among 18 patients with myocardial infarction,including 47 segments of hypokinesis,56 segments of akinesis and 6 segments of dyskinesis.The wall motion of 2 segments with hypokinesis before coronary revascularization which showed homogeneous opacification,14 of 24 segments with hypokinese and 20 of 24 segments with akinese before coronary revascularization which showed partial or reduced opaciflcation or subendocardial contrast defect was improved 3 months after coronary revascularization.In our study,the sensitivity and specificity of evaluation of myocardial viability after myocardial infarction by intravenous real-time myocardial contrast echocardiography were 94.7% and 78.9%,respectively.It was concluded that intravenous real-time myocardial contrast echocardiography could accurately evaluate myocardial viability after myocardial infarction.
基金supported by the Sichuan Provincial Science and Technology Department Funds of China (2019YFS0436).
文摘Here, a patient with chest pain and <50% stenosis on coronary angiography, where ATP stress myocardial contrast echocardiography (MCE) revealed that coronary flow reserve was reduced to 1.71 was presented. Perfusion delay occurred in the left ventricular wall of the apex of the heart before ATP stress, and the perfusion delay area was significantly reduced at peak stress. Similar to the characteristics of "reverse redistribution" of radionuclide myocardium perfusion in coronary vasospasm, the delayed perfusion area in the recovery period was larger than that detected before stress. Together with increased spectral resistance of the distal segment of left anterior descending coronary artery and chest pain, these findings indicated coronary microvascular disease with spasmodic characteristics in this patient. The perfusion characteristics on ATP stress determined by MCE and changes in coronary spectrum have value for the diagnosis and treatment of coronary microvascular disease with spasmodic characteristics.
文摘Background Both real-time three-dimensional echocardi ography (RT3DE) and myocardial contrast echocardiography (MCE) are novel imaging techniques. The purpose of this study was to confirm the feasibility and accuracy of RT3DE combined with MCE for quantitative evaluation of myocardial perfusion defects. Methods Thirteen dogs underwent ligation of the left anterior descending artery (LAD, n=6) or distal branch of the left circumflex artery (LCX, n=7) under general anaesthesia. Three to four ml of a perfluoropropane (C 3F 8) microbubble contrast agent was injected intravenously to assess the resulting myocardial perfusion defects with a commercially available Philips SONOS-7500 ultrasound system. After removal of the dog hearts, Evans blue dye was injected via the left and righ t coronary arteries to stain the myocardium at risk. In vitro anatomic measurements of myocardial mass after removal of the animals’ hearts were used as control s. Results Left ventricular (LV) mass determined by RT3DE ranged 36.7-68.9 g [mean, (54.6±9.6) g] before coronary artery ligation, and correlated highly (r=0.99) with in vitro measurement of LV mass [range, 38.9-71.1 g; mean, (55.6±9.3) g]. There was no significant difference between RT3DE and in vitro measurements of LV mass [range, 36.7-68.9 g; mean, (51.3±12.5) g. Or range, 38.9-71. 1 g; mean, (53.7±12.3) g, respectively] and under-perfused mass [range, 0-21.4 g; mean, (12.0±6.9) g. Or range, 0-19.8 g; mean, (10.8±6.3) g, respectively] after th e LAD ligation (P>0.05). Likewise, no significant difference was present between RT3DE and in vitro measurements of LV mass [range, 50.1-65.4 g; mean, (57.5±5.9 ) g. Or range, 51.5-65.8 g; mean, (57.3±6.4) g, respectively] and under-perfused m ass [range, 0-25.6 g; mean, (13.3±9.6) g. Or range, 0-22.7 g; mean, (12.8±8.1 ) g, respectively] after the LCX ligation (P>0.05). For all the animals with coronary ligation, LV mass measured by RT3DE ranged 35.9-68.6 g [mean, (54.8±10.0) g] a nd there was no significant difference between RT3DE and in vitro measurements of LV mass and under-perfused mass (P>0.05, r=0.99). Further, the under-perfused mass derived from RT3DE [range, 0-25.6 g; mean, (12.7±8.2) g] correlate d strongly with the in vitro measurements [range, 0-22.7 g; mean, (11.9±7.2) g] ( r=0.96). Conclusion RT3DE with MCE is a rapid and accurate method for estimating LV myocardial mass and quantifying perfusion defects.
文摘Background Quantitatively assessing myocardial perfusion and its reserve is of great importance for the diagnosis and stratification of patients with coronary artery disease (CAD), and represents an important goal of myocardial contrast echocardiography. In this study we sought to test the usefulness of low dose dobutamine stress real-time myocardial contrast echocardiography (RT-MCE) in the assessment of CAD, and to explore the relationship between perfusion reserve and contractile reserve.Methods Twenty-six patients with suspected or clinical diagnosed CAD were enrolled and underwent RT-MCE at baseline and under low dose dobutamine stress, and subsequent coronary angiography. RT-MCE images were analyzed quantitatively from microbubble replenishment curves for myocardial perfusion and its reserve. Results At baseline, significant differences in beta (0.28±0.12, 0.25±0.09, 0.22±0.06, 0.20±0.07 respectively, P<0.01) and A×beta (1.37±0.46, 1.28±0.47, 1.13±0.37, 0.91±0.32, respectively, P<0.01) were observed among four segment groups with graded coronary artery stenosis severity (normal; 30%-69% stenosis; 70%-90% stenosis; and beyond 90% stenosis), but not observed in parameter A. When under stress, significant differences in A (5.73±1.28, 5.63±1.01, 4.96±0.81, 4.57±0.62, respectively, P<0.01), beta (0.67±0.17, 0.55±0.19, 0.32±0.13, 0.25±0.08, respectively, P<0.01) and A×beta (3.81±1.20, 3.11±1.17, 1.59±0.82, 1.12±0.37, respectively, P<0.01) were observed among the formerly mentioned groups. Graded decreases in A reserve (1.20±0.53, 1.11±0.16, 0.98±0.12, 0.99±0.13, respectively, P<0.01), beta reserve (2.65±1.07, 2.32±0.82, 1.44±0.40, 1.29±0.34,respectively, P<0.01) and A×beta reserve (3.05±1.63, 2.59±1.01, 1.42±0.44, 1.27±0.34, respectively, P<0.01) could also be observed with increasing coronary stenosis severity. In five segments groups scored by WMS (1-5), concordance between contractile function and myocardial perfusion could be found both at rest (beta: 0.28±0.11, 0.22±0.08, 0.21±0.05, 0.17±0.05, 0.19±0.06, respectively, P<0.01; A×beta: 1.29±0.48, 0.98±0.45, 0.94±0.29, 0.76±0.30, 0.92±0.32, respectively, P<0.01) and under stress (beta: 0.59±0.20, 0.35±0.15, 0.27±0.08, 0.17±0.05, 0.20±0.05, respectively, P<0.01; A×beta: 3.07±1.38, 1.62±0.82, 1.28±0.40, 0.78±0.24, 0.93±0.22, respectively, P<0.01). This concordance is also valid in terms of the reserves, and the MCE parameters in segments with ameliorated contractile function are significantly higher than in those without. Conclusions Quantitative RT-MCE in conjunction with dobutamine stress shows promise in identifying and stratifying CAD and in exploring the perfusion-contractile correlation.
文摘Detection of abnormal myocardial perfusion is crucial to the prognosis of patients with coronary artery disease(CAD)after they have undergone percutaneous coronary intervention(PCI).The objective of this study is to evaluate the effect of myocardial perfusion by three different methods—intra-coronary myocardial contrast echocardiography(ICMCE),corrected thrombolysis in myocardial infarction frame count(CTFC),and coronary blood flow velocity(BFV)—and to determine the value of these different methods in the evaluation of the effect of myocardial perfusion post-PCI.For the study sixty-eight patients were divided into four groups based on selective coronary angiography results:group A(normal coronary artery),group B(75%–95%coronary artery stenosis),group C(coronary artery stenosis>95%)and group D(acute total coronary occlusion).The effect of myocardial reperfusion was evaluated using the above mentioned three methods 15 min after PCI.IC-MCE was also performed before PCI in group D.The quantitative parameters of MCE involved:contrast peak intensity,time to peak intensity and area under the curve,representing myocardial blood volume,reperfusion velocity and myocardial blood flow,respectively.No difference was found in CTFC between the coronary artery stenosis group and the normal group.BFV was slower in group D than in group A(P<0.05).The myocardial blood volume and the myocardial blood flow of the IC-MCE quantitative parameters were markedly lower in group C compared with those in group A(P<0.05),and there were significant differences in the three MCE parameters between group D and group A(P<0.05).For those patients with acute or total occlusion,the levels of myocardial perfusion before and after PCI were similar,as determined by IC-MCE and visually analyzed from 61 segments(P<0.05).Quantitative IC-MCE evaluation of myocardial reperfusion is more accurate than with the other two methods.Moreover,with qualitative IC-MCE the level of myocardial reperfusion can be viewed directly and rapidly.Thus,the IC-MCE method is of great value to coronary artery disease(CAD)patients undergoing PCI,especially for those with acute myocardial infarction(AMI).
文摘Background Time-intensity curves derived from microbubble destruction/refilling sequences and recorded using myocardial contrast echocardiography （MCE） can provide parameters that correlate with coronary blood flow. The response of these parameters to adenosine vasodilatation correlates with coronary flow reserve （CFR） measured by fluorescent microsphere techniques （FMT）. Currently, no data exist regarding the effect of physiological variables, such as hypoxia, on the determination of CFR by MCE. The purpose of this study was to define the effects of decreases in blood partial pressure of oxygen （PO2） on CFR as measured by MCE. Methods Studies were performed in 9 closed chest swine. Low-energy, real-time MCE was performed with commercial instruments in short axis view at papillary muscle level while infusing BR1 at 30 ml/h. High-energy ultrasound bursts （referred to as FLASH frames） destroyed the bubbles every 15 cardiac cycles, and resultant time-intensity curves derived from these sequences were fitted to the exponential function y = A （1-e -bt） +c, from which the rate of signal rise （b） was obtained. CFR was calculated as the ratio of b values after adenosine infusion to baseline and was obtained during the control period and after decreasing blood PO2 by giving nitrogen via a respirator to create artificial hypoxic conditions. CFR was independently determined by FMT. Results Nitrogen led to significant decreases in mean PO2, from （120.6±18.9） mmHg to （51.8±15.9） mmHg （P<0.01）. Adenosine produced a similar increase in CFR （2.5 fold vs 3.1 fold） as assessed by MCE and FMT during the control period. The decrease in PO2 post nitrogen resulted in a slight increase in values at rest: 0.46±0.15 to 0.53±0.18 for b and （1.39±0.66） ml·min -1·g -1 to （1.72±0.30） ml·min -1·g -1 for myocardial blood flow （MBF） （both P<0.05）. In addition, values decreased in response to adenosine using both techniques: 1.05±0.35 to 0.82±0.27 for b and （4.30±3.16） ml·min -1·g -1 to （3.93±1.27） ml·min -1·g -1 for MBF （both P<0.05）. Thus, CFR was markedly reduced under hypoxic conditions, to 1.4 by MCE （P<0.05 compared with the baseline）, and to 2.5 by FMT （P>05 compared with the baseline）. Conclusions CFR values diminish under hypoxic conditions according to both MCE and FMT. The reductions in CFR involve both an increase in resting values and a decrease in post adenosine measurements, as determined by both techniques. The reduction in CFR under hypoxia is slightly greater using MCE than using FMT. Physiological variables, such as hypoxia, must be taken into consideration when assessing CFR by MCE.
文摘Our understanding of coronary syndromes has evolved in the last two decades out of the obstructive atherosclerosis of epicardial coronary arteries paradigm to include anatomo-functional abnormalities of coronary microcirculation. No current diagnostic technique allows direct visualization of coronary microcirculation,but functional assessments of this circulation are possible. This represents a challenge in cardiology. Myocardial contrast echocardiography(MCE) was a breakthrough in echocardiography several years ago that claimed the capability to detect myocardial perfusion abnormalities and quantify coronary blood flow. Research demonstrated that the integration of quantitative MCE and fractional flow reserve improved the definition of ischemic burden and the relative contribution of collaterals in non-critical coronary stenosis. MCE identified no-reflow and low-flow within and around myocardial infarction,respectively,and predicted the potential functional recovery of stunned myocardium using appropriate interventions. MCE exhibited diagnostic performances that were comparable to positron emission tomography in microvascular reserve and microvascular dysfunction in angina patients. Overall,MCE improved echocardiographic evaluations of ischemic heart disease in daily clinical practice,but the approval of regulatory authorities is lacking.
文摘Echocardiography is the most common diagnostic method for assessing cardiac function but some limitations affect this technique.Until now,visual assessment of wall motion and thickening has allowed only a subjective evaluation of myocardial function and requires long-term training.Recently,new echocardiographic techniques have been introduced to evaluate myocardial mechanics.Tissue Doppler imaging(TDI)technique is limited by angle-dependency such that only deformation along the ultrasound beam can be derived from velocities,while myocardium deforms simultaneously in three dimensions.Speckle tracking echocardiography (STE)is a more recent technique that provides a global approach to left ventricular myocardial mechanics,giving information about the three spatial dimensions of cardiac deformation.In this editorial,we describe the physical and pathophysiological concepts of STE,discussing the differences compared to TDI and underlining the pitfalls of this new technique.
基金Supported by National Natural Science Foundation of China,No.81571686.
文摘BACKGROUND Endocardial fibroelastosis(EFE)is a rare heart disease characterized by thickening of the endocardium caused by massive proliferation of collagenous and elastic tissue,usually leading to impaired cardiac function.Multimodality cardiovascular imaging for the evaluation of EFE with thrombi is even rarer.CASE SUMMARY We report a rare case of EFE associated with multiple cardiovascular thrombi.Three-dimensional(3D)and contrast echocardiography(CE)were used to assess ventricular thrombi.Anticoagulant therapy was administered to eliminate the thrombi.The peripheral contrast-enhanced thrombi with the highest risk were dissolved with anticoagulant therapy at the time of reexamination,which was consistent with the presumption of fresh loose thrombi.CONCLUSION This new echocardiography technique has a great advantage in the diagnosis and treatment of EFE.On the basis of conventional echocardiography,3D echocardiography is used to display the position,shape,and narrow base of the thrombus.CE does not only help to confirm the diagnosis of thrombus,but also determines its risk.
文摘BACKGROUND Increasing reports have demonstrated that recombinant human brain natriuretic peptide(rhBNP)can improve acute myocardial infarction(AMI)and heart failure.However,whether it can improve renal function and decrease the risk of contrastinduced nephropathy(CIN)in elderly AMI patients is still unclear.AIM To explore the effect of rhBNP on CIN in elderly AMI patients after percutaneous coronary intervention(PCI).METHODS One hundred and thirty-one elderly AMI patients underwent PCI from January 2017 to July 2021.Patients were either given 1 mL of 0.9%normal saline/(kg/h)for 72 h after PCI(control group,n=66)and or intravenous rhBNP[1.5 mg/kg followed by 0.0075 mg/(kg/min)]for 72 h(rhBNP treatment group,n=65).Serum creatinine and cystatin C levels,creatinine clearance rate,and eGFR were measured at 24 h,48 h,and 72 h after PCI.Research nurses collected data on hand-written forms,and then stored them in password-protected electronic databases.RESULTS The creatinine clearance rate and eGFR were increased,while the creatinine and cystatin C levels were decreased significantly in the rhBNP treatment group compared to the control group at 48 h and 72 h.The incidence of CIN(P=0.028)and acute heart failure(P=0.017)also significantly decreased in the rhBNP group.No significant difference was noted between the two groups in cardiac death and recurrent AMI.CONCLUSION Early application of rhBNP could protect renal function and decrease the incidence of CIN after primary PCI and acute heart failure.
文摘Purpose: The aim of the present study was to evaluate the diagnostic accuracy for quantification of left ventricular (LV) volumes and LV ejection fraction (LVEF) with current echocardiographic methods of planimetry for analysis of LV remodeling after myocardial infarction in daily clinical routine. Methods: 26 patients were investigated directly after interventional therapy at hospital pre-discharge and at 6 month follow-up. Standardized 2D transthoracic native and contrast echocardiography were performed in all patients. Due to methodological aspects the results of LV volumes and LVEF using native echocardiography were compared to the results of LV opacification (LVO) imaging for analysis in mono-, bi- and triplane data sets using the Simpson’s rule. In addition corresponding multidimensional data sets were analyzed. Results: The assessment of LV volumes and LVEF is more accurate with contrast echocardiography. The comparison of LV volumes and LVEF shows significant increases using contrast echocardiography (p < 0.001). Larger left ventricular end-diastolic volumes (LVEDV) are measured at follow up (p < 0.05). Significant differences (p < 0.001) are found for the determination of LVEDV and LVEF relating to apical mono-, bi-, tri- and multiplane data sets. Standard deviations of the triplane approach, however, are significantly lower than using other modalities. Conclusion: Depending on the localization of the myocardial infarction LV volumes and LVEF are less reliably evaluated using the mono- or biplane approach. According to standardization and simultaneous acquisition of all LV wall segments the triplane approach is currently the best approach to determine LV systolic function. In addition, contrast echocardiography is indicated to improve endocardial border delineation in patients using the triplane or multiplane approach. To our knowledge the present study is the first systematic evaluation of all current possibilities for determination of LV volumes and LVEF by native and contrast echocardiography.
文摘BACKGROUND As an established,simple,inexpensive,and surprisingly effective diagnostic tool,right-heart contrast echocardiography(RHCE)might help in solving a vexing diagnostic problem.If performed appropriately and interpreted logically,RHCE allows for differentiation of various usual and unusual right-to-left shunts based on the site of injection and the sequence of microbubble appearance in the heart.CASE SUMMARY A 31-year-old woman was readmitted to hospital with a 2-mo history of worsening palpitation and chest distress.Two years prior,she had been diagnosed with postpartum pulmonary embolism by conventional echocardiography and computed tomography angiography.While the latter showed no sign of pulmonary artery embolism,the former showed pulmonary artery hypertension,moderate insufficiency,and mild stenosis of the aortic valve.RHCE showed microbubbles appearing in the left ventricle,slightly delayed after rightheart filling with microbubbles;no microbubbles appeared in the left atrium and microbubbles’appearance in the descending aorta occurred nearly simultaneous to right pulmonary artery filling with microbubbles.Conventional echocardiography was re-performed,and an arterial horizontal bidirectional shunt was found according to Doppler enhancement effects caused by microbubbles.The original computed tomography angiography findings were reviewed and found to show a patent ductus arteriosus.CONCLUSION RHCE shows a special imaging sequence for unexplained pulmonary artery hypertension with aortic valve insufficiency and simultaneous patent ductus arteriosus.
