Contrast Echocardiography Echocardiography Contrast Contrast - PowerPoint PPT Presentation

Contrast Echocardiography Echocardiography Contrast Contrast Echocardiography Jean- -Louis J. Louis J. Vanoverschelde Vanoverschelde, MD, PhD , MD, PhD Jean Université é catholique de catholique de Louvain Louvain Universit Brussels, Belgium Brussels, Belgium

Contrast Echocardiography Echocardiography Contrast Relation of µ µbubbles to red blood cells bubbles to red blood cells Relation of 1.00 1.00 2 x 120 10 2 x 120 10 8 8.10 8 8.10 bubbles µbubbles 100 100 ml - -1 1 ml 0.75 0.75 4.3 µ µm m 4.3 80 80 Transit time of µ Transit time of 0.50 0.50 60 60 40 40 0.25 0.25 20 20 0.00 0 0.00 0 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0 0 2 2 4 4 6 6 8 8 10 10 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 Diameter Diameter Transit time of red blood cells Transit time of red blood cells (µ µm) m) ( Jayaweera Jayaweera et al. et al. Circ. Res. Circ. Res. 1994 1994

Contrast Echocardiography Echocardiography Contrast Effect of low acoustic energy on µ µbubbles size bubbles size Effect of low acoustic energy on rarefaction rarefaction ultrasound ultrasound pressure pressure compression compression µbubble bubble µ radius radius

Contrast Echocardiography Echocardiography Contrast Effect of high acoustic energy on µ µbubbles bubbles Effect of high acoustic energy on rarefaction rarefaction ultrasound ultrasound pressure pressure compression compression µbubble bubble µ radius radius

Contrast Echocardiography Echocardiography Contrast Effect of acoustic energy on µ µbubbles scattering properties bubbles scattering properties Effect of acoustic energy on µbubble destruction µ bubble destruction Stimulated acoustic emission Stimulated acoustic emission MI > 1.0 MI > 1.0 1MPa 1MPa Non- -linear scattering properties linear scattering properties Non Harmonic frequency Harmonic frequency 100 kPa 100 kPa MI < 0.3 MI < 0.3 Non- -linear scattering properties linear scattering properties Non Fundamental and harmonic Fundamental and harmonic frequencies frequencies 0 kPa 0 kPa

Contrast Echocardiography Echocardiography Contrast Destruction of contrast by ultrasound Destruction of contrast by ultrasound 24 24 16 16 Intensity (dB) Intensity (dB) 8 8 0 0 0 80 160 240 320 0 80 160 240 320 Time (ms) Time (ms)

Contrast Echocardiography Echocardiography Contrast • Left ventricular opacification Left ventricular opacification • • Myocardial perfusion Myocardial perfusion • • Assessment of reperfusion and Assessment of reperfusion and • myocardial viability myocardial viability

Contrast Echocardiography Echocardiography Contrast Left ventricular opacification Left ventricular opacification Improved endocardial border endocardial border delineation delineation Improved • reduced reduced inter inter- - and and intra intra- -observer observer • variability variability • improved detection improved detection of of regional wall regional wall • motion abnormalities abnormalities motion • improved calculation improved calculation of LV volumes of LV volumes • and ejection fraction fraction and ejection

Contrast Echocardiography Echocardiography Contrast Inter- -institutional agreement according to image quality institutional agreement according to image quality Inter 120 120 100 100 Agreement in % Agreement in % 80 80 60 60 40 40 20 20 0 0 A B C D E A B C D E Hoffmann et al. Hoffmann et al. J Am Coll Cardiol J Am Coll Cardiol 1996;27:330 1996;27:330

Contrast Echocardiography Echocardiography Contrast

Contrast Echocardiography Echocardiography Contrast

Contrast Echocardiography Echocardiography Contrast NA, , 6 67 7 y.o. male y.o. male NA

Contrast Echocardiography Echocardiography Contrast NA, , 6 67 7 y.o. male y.o. male NA

Contrast Echocardiography Echocardiography Contrast Effect of left ventricular opacification on accuracy of DbE Effect of left ventricular opacification on accuracy of DbE 100 100 * * 80 80 60 60 LVO LVO (%) (%) 40 40 no LVO no LVO 20 20 0 0 % WTh Sensitivity Specificity Specificity Accuracy % WTh Sensitivity Accuracy Dolan et al. Am Heart J Dolan et al. Am Heart J 2001;142:908 2001;142:908

Contrast Echocardiography Echocardiography Contrast • Left ventricular opacification Left ventricular opacification • • Myocardial perfusion Myocardial perfusion • • Assessment of reperfusion and Assessment of reperfusion and • myocardial viability myocardial viability

Contrast Echocardiography Echocardiography Contrast Real- -time perfusion imaging using power modulation time perfusion imaging using power modulation Real

Contrast Echocardiography Echocardiography Contrast MCE versus MIBI for assessment of myocardial blood volume MCE versus MIBI for assessment of myocardial blood volume 5 5 MCE MBV MCE MBV 99m 99m Tc Tc- -MIBI MIBI LAD adenosine LAD adenosine 4 4 µspheres spheres µ LAD / Cx ratio LAD / Cx ratio 3 3 LAD stenosis + LAD stenosis + adenosine adenosine 2 2 1 1 LAD occlusion LAD occlusion 0 0 LAD LAD LAD stenosis occlusion LAD stenosis occlusion Ado Ado + Ado + Ado Wei Wei et al. et al. Am J Am J Physiol Physiol 2001,280:H1896. 2001,280:H1896.

Contrast Echocardiography Echocardiography Contrast How do we get from myocardial blood volume How do we get from myocardial blood volume to myocardial blood flow ? to myocardial blood flow ? DYNAMIC IMAGING DYNAMIC IMAGING

Contrast Echocardiography Echocardiography Contrast Quantification of myocardial blood flow Quantification of myocardial blood flow Flash Flash st cardiac nd cardiac rd cardiac th cardiac th cardiac 1 st cardiac 2 nd 3 rd 4 th 5 th 1 2 cardiac 3 cardiac 4 cardiac 5 cardiac cycle cycle cycle cycle cycle cycle cycle cycle cycle cycle time time

Contrast Echocardiography Echocardiography Contrast Real- -time perfusion imaging using power modulation time perfusion imaging using power modulation Real Van Camp et al., Van Camp et al., JASE JASE 2003;16:263 2003;16:263

Contrast Echocardiography Echocardiography Contrast Real- -time perfusion imaging using power modulation time perfusion imaging using power modulation Real Van Camp et al., Van Camp et al., JASE JASE 2003;16:263 2003;16:263

Contrast Echocardiography Echocardiography Contrast Real- -time perfusion imaging using power modulation time perfusion imaging using power modulation Real Stenosis + Adenosine Stenosis + Adenosine 18 18 16 16 14 14 Video intensity Video intensity 12 12 10 10 8 8 6 6 4 4 2 2 0 0 0 0 2 2 4 4 6 6 8 8 10 10 12 12 14 14 16 16 18 18 Time (s) Time (s) Van Camp et al., Van Camp et al., JASE JASE 2003;16:263 2003;16:263

Contrast Echocardiography Echocardiography Contrast Real- -time perfusion imaging using power modulation time perfusion imaging using power modulation Real 1.75 1.75 25 25 y = 0.45x - y = 0.45x - 6.26 6.26 y = 5.91x - y = 5.91x - 0.69 0.69 r = 0.93 r = 0.93 r = 0.91 r = 0.91 1.50 1.50 20 20 ) 1 ) ) 1 ) 1.25 1.25 -1 s - -1 ·s slope (s - (dB· β slope (s β (dB 15 15 1.00 1.00 A x β 0.75 0.75 A x 10 10 β 0.50 0.50 5 5 0.25 0.25 0.00 0.00 0 0 0 1 2 3 4 0 0 1 1 2 2 3 3 4 4 0 1 2 3 4 Microsphere blood flow Microsphere blood flow Microsphere blood flow Microsphere blood flow -1 1 .g -1 1 ) -1 1 .g -1 1 ) (ml.min - .g - ) (ml.min - .g - ) (ml.min (ml.min Van Camp et al., Van Camp et al., JASE JASE 2003;16:263 2003;16:263

Contrast Echocardiography Echocardiography Contrast MN, , 50 y.o. male 50 y.o. male MN Peltier et al. Peltier et al. J JACC ACC 2004;43:257 2004;43:257

Contrast Echocardiography Echocardiography Contrast MN, , 50 y.o. male 50 y.o. male MN DIPYRIDAMOLE MCE DIPYRIDAMOLE MCE Peltier et al. Peltier et al. J JACC ACC 2004;43:257 2004;43:257

Contrast Echocardiography Echocardiography Contrast MN, , 50 y.o. male 50 y.o. male MN DIPYRIDAMOLE MCE DIPYRIDAMOLE SPECT DIPYRIDAMOLE MCE DIPYRIDAMOLE SPECT Peltier et al. Peltier et al. J JACC ACC 2004;43:257 2004;43:257

Contrast Echocardiography Echocardiography Contrast MN, , 50 y.o. male 50 y.o. male MN DIPYRIDAMOLE MCE DIPYRIDAMOLE SPECT DIPYRIDAMOLE MCE DIPYRIDAMOLE SPECT Peltier et al. Peltier et al. J JACC ACC 2004;43:257 2004;43:257

Contrast Echocardiography Echocardiography Contrast Dipyridamole real- -t time Power Modulation ime Power Modulation Dipyridamole real 12 12 10 10 (dB) Videointensity (dB) 8 8 Videointensity 6 6 4 4 2 2 0 0 0 2 4 6 8 10 12 14 16 18 0 2 4 6 8 10 12 14 16 18 Time (s) Time (s) Peltier et al. Peltier et al. J JACC ACC 2004;43:257 2004;43:257