RESUMO
PURPOSE: The purpose of this study was to find out whether intravenous injection of a phospholipid-based left heart echo contrast agent improves the delineation of the left ventricular endocardial border. The influence of echo contrast on the quantification of left ventricular volumes, ejection fraction, regional wall function and interobserver variability was also assessed. METHOD: Prospectively, the apical 4-chamber view was recorded in 20 adult patients before and after intravenous injection of the contrast agent. Left ventricular endocardial border resolution was assessed in 5 segments and left ventricular volumes, ejection fraction, regional wall motion and interobserver variability were measured. RESULTS: After contrast injection a diagnostically useful left ventricular opacification was present in 18 patients (90%) and an optimal opacification in 14 patients (70%). Without contrast 1.05 endocardial segments could be delineated at end diastole and 1.8 segments at end systole. After contrast injection 3.65 endocardial segments were recognizable at end diastole (p < 0.01), 2.5 segments at end systole (p < 0.02). Left heart contrast improves interobserver-variability of end diastolic volume (p < 0.006), end systolic volume (p < 0.004), ejection fraction (p < 0.0002) and regional wall motion assessment (p < 0.03). Side effects did not occur. CONCLUSIONS: The intravenous injection of the investigated phospholipid-based echo contrast agent improves left ventricular endocardial border delineation and reproducibility of left ventricular volumes, ejection fraction and regional wall motion assessment.
Assuntos
Meios de Contraste , Doença das Coronárias/diagnóstico por imagem , Ecocardiografia , Endocárdio/diagnóstico por imagem , Função Ventricular Esquerda , Adulto , Idoso , Meios de Contraste/efeitos adversos , Doença das Coronárias/fisiopatologia , Diástole , Feminino , Humanos , Injeções Intravenosas , Masculino , Pessoa de Meia-Idade , FosfolipídeosRESUMO
In the present study, we investigated whether the intravenous injection of air-filled albumin microspheres (Infoson) as a contrast medium improves the echocardiographic quantification of left ventricular enddiastolic and endsystolic volumes, stroke volume, ejection fraction, and regional wall motion in patients with suboptimal endocardial border definition on echocardiography. In 30 adult patients, apical two and four chamber views were performed. In comparison to biplane cineventriculography enddiastolic and endsystolic volumes, stroke volume, ejection fraction, and regional wall function were assessed for heart cycles with and without left ventricular contrast. In comparison to biplane cineventriculography echocardiography underestimates enddiastolic (167+/-64 ml, 111+/-43; p<0.0001) and endsystolic volumes (77+/-63 ml, 54+/-40 ml; p<0.0002), stroke volume (90+/-25 ml, 57+/-17 ml; p<0.0001), and ejection fraction (58+/-16%, 55+/-14%; p<0.03). By contrast echocardiography ejection fraction (58+/-16%) agreed with the angiocardiographically measured ejection fraction. Furthermore, after contrast injection correlations improved between cineventriculography and echocardiography for the assessment of left ventricular enddiastolic volumes (without contrast r = 0.90, SEE = 19 ml; with contrast r = 0.93, SEE = 19 ml), endsystolic volumes (without contrast r = 0.94, SEE = 14 ml; with contrast r = 0.95, SEE = 15 ml), stroke volume (without contrast r = 0.63, SEE = 14 ml; with contrast r = 0.67, SEE = 14 ml), ejection fraction (without contrast r = 0.84, SEE = 8%; with contrast r = 0.88, SEE = 7%), regional wall motion (p<0.01) and its reproducibility (p<0.02). In adult patients with suboptimal endocardial border delineation intravenous contrast echocardiography improves the assessment of left ventricular ejection fraction, regional wall motion, and its reproducibility without severe side effects.
