medigraphic.com

2005, Number 2

<< Back Next >>

Arch Cardiol Mex 2005; 75 (2)

Contrast echocardiography in myocardial perfusion today

Molina-Carrión M, Lozano JL, Zabalgoitia M

Language: Spanish
References: 33
Page: 197-209
PDF size: 316.07 Kb.


ABSTRACT

Advances in ultrasonic engineering have made possible the development of “intelligent” microparticles with the capacity of passing through the pulmonary circulation in sufficient amount to acquire images of the left heart, making possible the evaluation of myocardial perfusion. Although the Food and Drug Administration of the United States has approved several contrast agents for use in ventricular opacification and visualization of endocardial borders in subjects that have suboptimal studies, at this time, it has not approved any agent of contrast for use in myocardial perfusion. Currently, there are two multicenter studies on a great scale that were exclusively designed for myocardial perfusion in comparison with nuclear medicine and angiography. Our laboratory has had the opportunity to actively participate in both trials. This revision includes the design, interpretation criteria, and preliminary results of CARDIOsphere. As well, we are presenting the interpretation criteria of the AI-700 bubble, which is currently in phase III of clinical investigation. Myocardial perfusion assessment with contrast echocardiography faces several challenges that need to be addressed before it becomes established as an efficient alternative. A common limitation is the viability of this method in subjects with bad acoustic window, the creation of intrinsic artifacts to the system, as distal and lateral attenuation; the unavoidable learning curve, and the settlement of defect quantification criteria.


REFERENCES

  1. Gramiak R, Shah PM: Echocardiography of the aortic root. Invest Radiol 1968; 3: 356-366.

  2. Gramiak R, Nanda NC, Shah PM: Echocardiography detection of the pulmonary valve. Radiology 1972; 102: 153-157.

  3. DeMaria AN, Bommer WJ, Riggs K: Echocardiography visualization of myocardial perfusion by left heart an intracoronary injections of echo contrast agents. (abstr) Circulation 1980; 62(Suppl. II): 143.

  4. Feinstein SB, Shah PM, Bing RJ: Microbubble dinamycs visualization in the intact capillary circulation. J A Coll Cardiol 1984a; 4: 595-600.

  5. Villanueva FS, Glashen WP, Sklenar J: Assessment of risk area during coronary occlusion and infarct size after reperfusion with myocardial contrast echocardiography using left and right atrial injections of contrast. Circulation 1993; 88: 596.

  6. Shroder K, Agrawal R, Voller H, Schilief R, Scroder R: Improvenment of endocardial border delineation in suboptimal stress- echocardiograms using the new heart contrast agent SH U 508 a. Int J Cardia Imagin 1994; 10: 45-51.

  7. Porter T, Xie F, Kricsfeld A, Chiou A, Dabestani A: Improved endocardial border resolution during dobutamine stress echocardiography with intravenous sonicated dextrose albumin. J A Coll Cardiol 1994; 23: 1440-1443.

  8. Falcone RA, Marcovitz PA, Perez JE, Dittrich HC, Hopkins WE, Armstrong WF: Intravenous albuminex during dobutamine stress echocardiography: Enhanced localization of left ventricular endocardial borders. A Heart J 1995; 130: 254-258.

  9. Jayaweera AR, Edwards N, Glasheen WP, Villanueva FS, Abbott RD, Kaul S: In vivo myocardial kinetics of air-filled albumin microbubbles during myocardial contrast echocardiography. Comparison with radiolabeled red blood cells. Circ Res 1994; 74: 1157-1165.

  10. Porter TR, Xie F, Kricsfeld A, Deligonul U, Kilzer K: Reduction in left ventricular cavitary attenuation and improvement in posterior myocardial contrast with higher molecular weight intravenous perfluorocarbon-exposed sonicated dextrose albumin microbubbles. J Am Soc Echocardiogr 1996; 9: 437-441.

  11. Ota T, Hillman ND, Craig D, Kisslo J, Smith PK: Contrast echocardiography: influence of ultrasonic machine settings, mixing conditions, and pressurization on pixel intensity and microsphere size of Albunex solutions in vitro. J Am Soc Echocardiogr 1997; 10: 31-40.

  12. Miller AP, Nanda N: Contrast Echocardiography: New Agents. Ultrasound in Med and Biol 2004; 30(4): 425-434.

  13. Morse PM, Ingard KU: Theoretical acoustics. New York: McGraw-Hill 1968: 436-441.

  14. García Fernández MA, García Orta R, Martínez Selles M: Avances en ecocardiografía. Ecocardiografía de contraste. En: Ayuela JM, López Pérez JM, Fiol M. Ecocardiografía en el paciente crítico. Barcelona. Springer-Berlag-Iberic. 2000: 376-381.

  15. De Jong N, Comet R, Lancee CT: Higher harmonics of vibrating gas-filled microspheres. Part one: simulations. Ultrasonics 1994; 32: 447-453.

  16. Wei K, Skyba DM, Firschke C, Jayaweera AR, Lindner JR, Kaul S: Interactions between microbubbles and ultrasound: in vitro and in vivo observations. J Am Coll Cardiol 1997; 29: 1081-1088.

  17. De Jong N, Hoff L, Skotland T, Bom N: Absorption and scatter of encapsulated gas filled microspheres: theoretical considerations and some measurements. Ultrasonics 1992; 30: 95-103.

  18. Miller DL: Ultrasonic detection of resonant cavitation bubbles in a flow tube by their second-harmonic emissions. Ultrasonics 1981; 19: 217-224.

  19. Burns PN: Harmonic imaging with ultrasound contrast agents. Clin Radiol 1996; 51: 50-55.

  20. De Jong N, Cornet R, Lancee CT: Higher harmonics of vibrating gas-filled microspheres. Part two: measurements. Ultrasonics 1994; 32: 455-459.

  21. Porter TR, Xie F, Li S, et al: Increased ultrasound contrast and decreased ultrasound destruction rates with triggered ultrasound imaging. J Am Soc Echo- Cardiogr 1996; 9: 599-605.

  22. Rubin DN, Thomas JD: New Imaging Technology: measurement of myocardial perfusion by contrast echocardiography. Coronary Artery Disease 2000; 11: 221-226.

  23. Porter TR, Xie F: Transient myocardial contrast following initial exposure to diagnostic ultrasound pressures with minute doses of intravenously injected micro bubbles: demonstration and potential mechanisms. Circulation 1995; 92: 2391-2395.

  24. Monaghan MJ: Contrast Echocardiography: from left ventricular opacification to myocardial perfusion. Are the promises to be realized? Heart 2003; 89: 1389-1390.

  25. Zierler KR: A simplified explanation of the theory of indicator-dilution for measurement of fluid flow and volume and other distributive phenomena. Bull Johns Hopkins Hosp 1958; 103: 199-223.

  26. Meier P, Zierfer KL: On the theory of indicator-dilution method for measurement of blood flow and volume. J Appl Physiol 1954; 6: 731-740.

  27. Powsner SM, Keller MW. Saniie J, Feinstein SB: Quantitation of echo-contrast effects. Am J Physiologic Imaging 1986; 1: 124-128.

  28. Oraby MA, Hays J, Maklady FA, El-Hawary AA, Yaneza LO, Zabalgoitia M: Comparison of real-time coherent contrast imaging to dipyridamole thallium-201 single-photon emission computed tomography for assessment of myocardial perfusion and left ventricula rwall motion. Am J Cardiol 2002; 90: 449-54.

  29. Orobay MA, Hays J, Maklady FA, El-Hawary AA, Zabalgoitia M: Assessment of myocardial perfusion during pharmacologic contrast stress echocardiography. Am J Cardiol 2002; 89: 640-4.

  30. Pointbio: Demostración del producto. Página web: www.pointbio.com 2005

  31. Acusphere: Demostración del producto. Página web: www.acuspher.com 2005

  32. Walovitch RC, Kwan OL, Picard MH: Inicial safety and myocardial perfusion imaging results with AI-700 synthetic polymeric ultrasound contrast agent. J Am Soc Echocardiogr 2000; 13(251A): 457.

  33. Church C: The acoustical responses of AI-700 in vitro. J Am Soc Echocardiogr 2000; 13(251B): 457.




2020     |     www.medigraphic.com