shu-508 and Cardiomyopathy--Dilated

We sought to evaluate whether contrast-enhanced Doppler echocardiography can improve the noninvasive estimation of hemodynamic variables in left ventricular (LV) dysfunction. Right-heart catheterization and Doppler echocardiography were simultaneously performed in 45 patients with LV dysfunction (ejection fraction: 29 +/- 7%) in sinus rhythm. Noninvasive variables were estimated as follows: cardiac output by pulsed Doppler of LV outflow tract; pulmonary capillary wedge pressure by a regression equation including mitral and pulmonary venous flow variables; pulmonary artery mean pressure from the calculated systolic and diastolic pulmonary artery pressures; and pulmonary vascular resistance from the previous measurements according to hemodynamic definition. Contrast enhancement increased the feasibility of pulmonary capillary wedge pressure estimation from 60% to 100%; of pulmonary artery mean pressure from 42% to 91%; and of pulmonary vascular resistance from 42% to 91%. Strong correlations between invasive and noninvasive hemodynamic variables were found: r = 0.90, standard error of the estimate (SEE) 0.45 L/min for cardiac output; r = 0.90, SEE 3.1 mm Hg for pulmonary capillary wedge pressure; r = 0.93, SEE 3.7 mm Hg for pulmonary artery mean pressure; and r = 0.85 SEE 1.0 Wood units for pulmonary vascular resistance. Weaker correlations for PAMP (r = 0.82, SEE 5.6 mm Hg) and PVR (r = 0.66, SEE 1.7 Wood units) were apparent prior to contrast enhancement. When patients were separated according to PVR threshold values, the contrast allowed the correct placement of 88% of patients, whereas only 57% were correctly assigned without it. The contrast increased accuracy and reduced interobserver variability in the evaluation of hemodynamic variables. The contrast-enhanced study is capable of increasing the value of noninvasive hemodynamic assessment in LV dysfunction.

Topics: Adult; Aged; Cardiomyopathy, Dilated; Chronic Disease; Contrast Media; Echocardiography, Doppler; Female; Hemodynamics; Humans; Image Enhancement; Infusions, Intravenous; Male; Middle Aged; Observer Variation; Polysaccharides; Pulmonary Wedge Pressure; Systole; Vascular Resistance; Ventricular Dysfunction, Left

The enhancement of endocardial border delineation using second harmonic imaging and contrast administration improves the measurement of ventricular volumes. In the majority of existing echocardiographic equipment, however, harmonic imaging is not yet available. The aim of this study was to assess the feasibility of the measurement of left ventricular volumes and ejection fraction after intravenous administration of the contrast agent Levovist using standard echocardiographic equipment and fundamental imaging modality. In 10 patients with good-quality two-dimensional echo imaging, 4 g (400 mg/mL concentration) of Levovist was injected intravenously. Hewlett-Packard Sonos 2000 ultrasound equipment without second harmonic imaging capability was used. To avoid the destruction of microbubbles, the echo machine was set to produce only one end-systolic and one end-diastolic frame in each cardiac cycle (dual triggering). Native and contrast imaging measurements of left ventricular volumes and ejection fractions calculated by modified Simpson's rule were compared in the fundamental mode. Intraobserver and interobserver variability values were assessed. End-diastolic volumes in native continuous and triggered mode and by contrast echo were 126 +/- 48, 121 +/- 46, and 130 +/- 50 mL, respectively (NS), whereas end-systolic volumes were 79 +/- 48, 76 +/- 45, and 79 +/- 46 mL, respectively (NS). Calculated ejection fraction using the three different imaging modalities were 0.41 +/- 0.16, 0.41 +/- 0.16, and 0.42 +/- 0.16 (NS). The intraobserver and interobserver reproducibility values were excellent in triggered mode. Standard echocardiographic equipment with fundamental imaging modality in the triggered mode is suitable for the measurement of left ventricular volumes after intravenous Levovist administration. In clinically difficult patients, contrast echocardiography in triggered mode may be applied even if echocardiographic equipment does not have harmonic imaging possibility.

Topics: Cardiomyopathy, Dilated; Contrast Media; Echocardiography; Feasibility Studies; Humans; Injections, Intravenous; Middle Aged; Myocardial Infarction; Observer Variation; Polysaccharides; Reproducibility of Results; Stroke Volume