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Contrast Echocardiography Contrast Echocardiography
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Contrast Echocardiography Contrast Echocardiography
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Jean-Louis J. Vanoverschelde, MD, PhD. Contrast Echocardiography. Contrast Echocardiography. Université catholique de Louvain. Brussels, Belgium ...
Contrast Echocardiography
Jean-Louis J. Vanoverschelde, MD, PhD Université catholique de Louvain Brussels, Belgium
Contrast Echocardiography Relation of µ bubbles to red blood cells 1.00
102 x 120 100 80
Transit time of µ bubbles
8.108 ml-1 4.3 µ m
60 40 20 0 0
2
4
6
Diameter (µ m)
8
10
0.75
0.50
0.25
0.00 0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
Transit time of red blood cells Jayaweera et al. Circ. Res. 1994
Contrast Echocardiography Effect of low acoustic energy on µ bubbles size
ultrasound pressure
µ bubble radius
rarefaction compression
Contrast Echocardiography Effect of high acoustic energy on µ bubbles
ultrasound pressure
µ bubble radius
rarefaction compression
Contrast Echocardiography Effect of acoustic energy on µ bubbles scattering properties
µ bubble destruction Stimulated acoustic emission 1MPa
MI > 1.0
Non-linear scattering properties Harmonic frequency 100 kPa
MI < 0.3
Non-linear scattering properties Fundamental and harmonic frequencies 0 kPa
Contrast Echocardiography Destruction of contrast by ultrasound
Intensity (dB)
24
16
8
0 0
80
160
240
Time (ms)
320
Contrast Echocardiography
• • •
Left ventricular opacification Myocardial perfusion Assessment of reperfusion and myocardial viability
Contrast Echocardiography Left ventricular opacification
Improved endocardial border delineation • reduced inter- and intra-observer variability • improved detection of regional wall motion abnormalities • improved calculation of LV volumes and ejection fraction
Contrast Echocardiography Inter-institutional agreement according to image quality 120
Agreement in %
100 80 60 40 20 0
A
B
C
D
E Hoffmann et al. J Am Coll Cardiol 1996;27:330
Contrast Echocardiography
Contrast Echocardiography
Contrast Echocardiography NA, 67 y.o. male
Contrast Echocardiography NA, 67 y.o. male
Contrast Echocardiography Effect of left ventricular opacification on accuracy of DbE 100
* 80
LVO
40
no LVO
(%)
60
20
0 % WTh
Sensitivity Specificity Accuracy Dolan et al. Am Heart J 2001;142:908
Contrast Echocardiography
• • •
Left ventricular opacification Myocardial perfusion Assessment of reperfusion and myocardial viability
Contrast Echocardiography Real-time perfusion imaging using power modulation
Contrast Echocardiography MCE versus MIBI for assessment of myocardial blood volume 5 MCE MBV 99mTcTc-MIBI
LAD adenosine
LAD / Cx ratio
LAD stenosis + adenosine
4
µ spheres
3
2
1 LAD occlusion 0 LAD Ado
LAD stenosis + Ado
occlusion
Wei et al. Am J Physiol 2001,280:H1896.
Contrast Echocardiography
How do we get from myocardial blood volume to myocardial blood flow ?
DYNAMIC IMAGING
Contrast Echocardiography Quantification of myocardial blood flow Flash
1st cardiac 2nd cardiac 3rd cardiac 4th cardiac cycle cycle cycle cycle
time
5th cardiac cycle
Contrast Echocardiography Real-time perfusion imaging using power modulation
Van Camp et al., JASE 2003;16:263
Contrast Echocardiography Real-time perfusion imaging using power modulation
Van Camp et al., JASE 2003;16:263
Contrast Echocardiography Real-time perfusion imaging using power modulation Stenosis + Adenosine
18
Video intensity
16 14 12 10 8 6 4 2 0 0
2
4
6
8
10
12
14
16
18
Time (s) Van Camp et al., JASE 2003;16:263
Contrast Echocardiography Real-time perfusion imaging using power modulation 1.75
25
y = 0.45x - 6.26 r = 0.93
1.50
y = 5.91x - 0.69 r = 0.91
A x β (dB·s-1)
β slope (s-1)
20 1.25 1.00 0.75 0.50
15
10
5 0.25 0.00
0 0
1
2
3
4
0
1
2
3
Microsphere blood flow
Microsphere blood flow
(ml.min-1.g-1)
(ml.min-1.g-1)
4
Van Camp et al., JASE 2003;16:263
Contrast Echocardiography MN, 50 y.o. male
Peltier et al. JACC 2004;43:257
Contrast Echocardiography MN, 50 y.o. male DIPYRIDAMOLE MCE
Peltier et al. JACC 2004;43:257
Contrast Echocardiography MN, 50 y.o. male DIPYRIDAMOLE MCE
DIPYRIDAMOLE SPECT
Peltier et al. JACC 2004;43:257
Contrast Echocardiography MN, 50 y.o. male DIPYRIDAMOLE MCE
DIPYRIDAMOLE SPECT
Peltier et al. JACC 2004;43:257
Contrast Echocardiography Dipyridamole real-time Power Modulation 12
Videointensity (dB)
10 8 6 4 2 0 0
2
4
6
8
10
Time (s)
12
14
16
18
Peltier et al. JACC 2004;43:257
Contrast Echocardiography Dipyridamole real-time Power Modulation 1.25 n=292
β slope (s-1)
1.00
n=32
n=92
n=42
* *
0.75
*† *†
0.50 0.25 0.00 Rest Dip
Rest Dip
Rest Dip
Rest Dip
< 50%
50-70%
70-90%
> 90% Peltier et al. JACC 2004;43:257
Contrast Echocardiography Dipyridamole real-time Power Modulation
β reserve
3
2
1 0.09(x-100)) y = 2.65 (1(1-e-0.09(xr = 0.85
0 0
20
40
60
80
100
% luminal diameter stenosis Peltier et al. JACC 2004;43:257
Contrast Echocardiography Dipyridamole real-time Power Modulation
Sensitivity (%)
β reserve
A * β reserve
100
100
75
75
50
50
Area under the curve =0.85
25
Area under the curve =0.86
25
0
0 100
75
50
25
Specificity (%)
0
100
75
50
25
0
Specificity (%) Peltier et al. JACC 2004;43:257
Contrast Echocardiography Dipyridamole RTCE: Prognostic implications 100
Normal MP
Event fre survival (%)
Fixed perfusion defect
80
Inducible perfusion defect
60
40 Fixed + inducible perfusion defect
20 P
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