shu-508 and Heart-Diseases

Echo enhancing agents have been used in echocardiography since 1968 for a variety of applications. Until recently, the agents were unable to survive transit through the pulmonary circulation following intravenous injection, and the technique was therefore restricted to investigations of the right side of the heart. Levovist is an echo enhancing agent capable of left heart--and even systemic--enhancement to improve the images obtained with B-mode and Doppler echocardiography. This agent offers important practical advantages in "routine" echocardiography, particularly in patients in whom image quality is suboptimal or baseline examination fails due to physical limitations. Potential future uses of contrast-enhanced echocardiography include quantitative analysis of coronary artery flow.

Topics: Blood Flow Velocity; Contrast Media; Coronary Vessels; Echocardiography; Heart Diseases; Heart Ventricles; Humans; Infusions, Intravenous; Lung; Polysaccharides; Ventricular Function

Transthoracic echocardiography often provides inadequate endocardial border visualization, particularly of the left ventricular apex. The aim of this study was to determine whether the transpulmonary echocardiographic contrast agent, Levovist, could improve endocardial visualization. Accordingly, 43 patients underwent 2-dimensional echocardiography before and after intravenous administration of Levovist. Definition of the left ventricular septal, apical and lateral borders was graded: 0 = no definition, 1 = partial definition, 2 = complete definition. Color Doppler was performed before and after contrast in 32/43 patients and similarly scored to determine any further benefit in apical border detection. There was significant (p < 0.001) improvement of the average end-diastolic scores of the septal, apical and lateral regions (1.4 +/- 0.5, 0.6 +/- 0.7 and 0.9 +/- 0.5 before and 1.8 +/- 0.4, 1.4 +/- 0.6 and 1.7 +/- 0.5 after Levovist). The average end-systolic score was significantly different (p < 0.001) from end-diastolic values in the apex only (0.3 +/- 0.6 before and 0.8 +/- 0.7 after Levovist). Average apical scores using color Doppler improved from 0.3 +/- 0.6 and 0.1 +/- 0.2 during end-diastole and end-systole to 1.7 +/- 0.5 and 1.2 +/- 0.6, respectively, after Levovist (p < 0.001); the average end-diastolic contrast-enhanced color Doppler score was significantly higher than the corresponding grey scale score (p < 0.001). We conclude that left ventricular endocardial border definition is significantly improved by Levovist. The use of contrast enhanced color Doppler can compensate for limited efficacy of this method in the apex.

Topics: Adult; Aged; Aged, 80 and over; Contrast Media; Echocardiography; Echocardiography, Doppler, Color; Endocardium; Female; Heart Diseases; Heart Ventricles; Humans; Male; Middle Aged; Polysaccharides; Ventricular Function, Left

Although detecting left ventricular thrombus in anterior myocardial infarction is important for the prevention of embolic events, imaging of apical thrombus is often difficult using conventional echocardiography. We examined whether contrast echocardiography improves sensitivity and specificity in detecting thrombus in the left ventricle in comparison with conventional echocardiography alone in patients with anterior myocardial infarction. Participants in this single-center prospective study comprised 392 patients with anterior myocardial infarction admitted between 2000 and 2006. After conventional echocardiography, all patients underwent contrast echocardiography (left ventricular opacification and myocardial contrast echocardiography) during intravenous drip infusion of contrast media at rest. Left ventricular thrombus was diagnosed based on left ventriculography or multidetector-row computed tomography (MDCT). Mural left ventricular thrombus was confirmed by left ventriculography and/or MDCT in 32 of 393 patients (8 %). Sensitivity and specificity of conventional echocardiography alone were 88 % and 96 %, respectively, compared with 100 % each with contrast echocardiography. Among the 32 patients with left ventricular thrombus, 25 patients (78 %) showed no perfusion in the anterior wall on myocardial contrast echocardiography, even with a four-beat interval. In conclusion, contrast echocardiography offers a clinically feasible and useful method for noninvasively evaluating left ventricular thrombus in anterior myocardial infarction.

Topics: Aged; Anterior Wall Myocardial Infarction; Contrast Media; Feasibility Studies; Female; Heart Diseases; Humans; Infusions, Intravenous; Japan; Male; Multidetector Computed Tomography; Polysaccharides; Predictive Value of Tests; Prospective Studies; Thrombosis; Ultrasonography

Low flow velocity within the left atrial appendage, as assessed by transoesophageal echocardiography, is a predictor of thromboembolism and of a low success rate of cardioversion of atrial fibrillation. However, the semi-invasive nature does limit its serial application as a screening technique.. We investigated the value of transthoracic second harmonic echocardiography and pulsed Doppler at baseline and after intravenous contrast injection to visualize the left atrial appendage and assess blood flow velocities within its cavity. We studied 51 consecutive patients undergoing transoesophageal echocardiography. After transoesophageal echocardiography, transthoracic second harmonic imaging was performed and the left atrial appendage was visualized in 46 patients. Interpretable pulsed Doppler tracings of left atrial appendage flow were obtained at baseline in 39 patients and in 45 patients during Levovist administration. The correlations between peak emptying velocity of left atrial appendage as measured by transoesophageal echocardiography and by transthoracic standard and contrast-enhanced Doppler were 0.81 and 0.91, respectively. The agreement between transoesophageal echocardiography and transthoracic contrast-enhanced pulsed Doppler echocardiography in classifying left atrial appendage flow velocity patterns was 93%. Left atrial appendage thrombus was detected by transthoracic second harmonic imaging in only one of the eight patients shown by transoesophageal echocardiography to have a thrombus. However, all but one of the patients with left atrial appendage thrombus and/or spontaneous echocardiographic contrast at transoesophageal echocardiography had <30cm/s left atrial appendage flow velocity by transthoracic Doppler.. This study shows that left atrial appendage can be visualized by transthoracic second harmonic imaging and that the flow velocity within its cavity is reliably measured by pulsed Doppler in a substantial fraction of patients. Contrast enhancement improves the feasibility and the accuracy of transthoracic evaluation of left atrial appendage flow velocity. The practical value of these results in predicting thromboembolic risk and success of cardioversion of atrial fibrillation needs to be proved by prospective studies.

Topics: Aged; Atrial Appendage; Blood Flow Velocity; Contrast Media; Echocardiography; Echocardiography, Doppler, Pulsed; Echocardiography, Transesophageal; Female; Heart Diseases; Humans; Male; Polysaccharides; Thrombosis

The need to enhance the echocardiographic determination of left ventricular ejection fraction is greatest in patients with suboptimal images. Intravenous contrast (CON) and tissue harmonic imaging (THI) are 2 important methods for enhancing endocardial border definition. However, the comparative feasibility and accuracy of THI and contrast-enhanced power harmonic imaging in difficult-to-image patients have not been examined. We assessed the comparative accuracy of THI and CON in determining EF and ventricular volumes in patients with suboptimal fundamental images. We demonstrated that CON is feasible and exhibits a greater correlation with ejection fraction and ventricular volumes determined by radionuclide angiography (standard of comparison) than THI in this difficult-to-image population, with no reported side effects. For both ejection fraction and ventricular volumes, the observer variability was least for CON, intermediate with THI, and greatest for fundamental imaging.

Topics: Adult; Aged; Aged, 80 and over; Cardiac Volume; Contrast Media; Echocardiography; Feasibility Studies; Female; Heart Diseases; Heart Ventricles; Humans; Injections, Intravenous; Male; Middle Aged; Observer Variation; Polysaccharides; Prospective Studies; Radionuclide Angiography; Reproducibility of Results; Stroke Volume; Tin Polyphosphates

Harmonic power imaging (HPI) is a new echocardiographic modality that enhances the detection of contrast agents in the left ventricle. The endocardium can be delineated by conventional echocardiography using ultrasound contrast agents, although the images tend to be faint. The present study was designed to assess left ventricular volume using HPI after intravenous injection of the contrast agent Levovist (Schering SA, Berlin, Germany) in 25 unselected patients. End-diastolic volume, end-systolic volume, and ejection fraction were determined for each patient with angiography and with 4 different ultrasound modalities: (1) conventional mode without contrast, (2) contrast conventional mode, (3) contrast harmonic intermittent imaging mode, and (4) contrast triggered HPI. The use of HPI improved correlations between the echographic and angiographic measurements for all parameters as well as precision and bias determined by Bland and Altman analysis. The relative errors for interobserver variability were also lower with HPI. This study demonstrates that echocardiographic determination of left ventricular volumes and ejection fraction is more accurate and reproducible using HPI combined with Levovist.

Topics: Angiography; Blood Pressure; Contrast Media; Echocardiography; Female; Heart Diseases; Humans; Linear Models; Male; Middle Aged; Polysaccharides; Reproducibility of Results; Stroke Volume

Noninvasive pressure estimation in heart cavities and in major vessels would provide clinicians with a valuable tool for assessing patients with heart and vascular diseases. Some microbubble-based ultrasound contrast agents are particularly well suited for pressure measurements because their substantial compressibility enables microbubbles to vary significantly in size in response to changes in pressure. Pressure changes should then affect reflectivity of microbubbles after intravenous injection of a contrast agent. This has been demonstrated with a galactose-based contrast agent using 2.0-MHz ultrasound tone bursts. Preliminary results indicate that, over the pressure range of 0-186 mmHg, the subharmonic amplitude of scattered signals decreases by as much as 10 dB under optimal acoustic settings and the first and second harmonic amplitudes decrease by less than 3 dB. An excellent correlation between the subharmonic amplitude and the hydrostatic pressure suggests that the subharmonic signal may be utilized for noninvasive detection of pressure changes.

Topics: Contrast Media; Heart Diseases; Humans; Hydrostatic Pressure; Polysaccharides; Pressure; Ultrasonography; Vascular Diseases

Contrast-enhanced 2-dimensional echocardiography without color Doppler did not result in complete filling of the left ventricular cavity in 21 patients studied. However, contrast-enhanced color Doppler was very effective and provided complete opacification of the left ventricular cavity in 20 of these 21 patients.

Topics: Adult; Aged; Aged, 80 and over; Cardiac Volume; Contrast Media; Echocardiography; Echocardiography, Doppler, Color; Female; Heart Diseases; Heart Ventricles; Humans; Image Enhancement; Male; Middle Aged; Mitral Valve Insufficiency; Polysaccharides; Stroke Volume; Thrombosis

We tested the hypothesis that SHU 508A, a new lung-crossing contrast agent capable of increasing the Doppler signal to noise ratio in the right heart as well as left heart cavities after intravenous injection, could increase Doppler signal intensity in coronary arteries, thus improving the feasibility and quality of transesophageal Doppler echocardiographic evaluation of coronary blood flow velocity.. Coronary blood flow velocity can be evaluated by transesophageal Doppler echocardiography. However, an adequate Doppler tracing is obtainable in a relatively low percent of patients.. Transesophageal Doppler echocardiography of coronary arteries was performed in 35 patients before and after SHU 508A injection at four different dosages (200 mg/ml in 5 ml, 200 mg/ml in 10 ml, 300 mg/ml in 5 ml and 300 mg/ml in 10 ml). Color Doppler mapping of coronary flow and pulsed wave Doppler measurement of coronary blood flow velocity were attempted in all patients.. Color Doppler flow mapping of 105 evaluated coronary segments (left main, left anterior descending and circumflex in 35 patients) was not detectable or was weak in 88% of patients before and 33% of patients after echo contrast injection (p < 0.0001); it was optimal (that is, well delineated with complete flow mapping of the explored vessel) in only 11% of patients before and 67% after echo contrast injection (p < 0.0001). In addition, pulsed wave Doppler signal quality improved after echo contrast injection: Pulsed wave Doppler recording of coronary blood flow velocity was not obtainable or was weak in 78% of cases before and 34% after echo contrast injection (p < 0.0001); pulsed wave Doppler recording of coronary blood flow velocity was optimal (that is, there was a complete and well defined outline of diastolic coronary blood flow velocity in 23% of cases before and 66% after echo contrast injection [p < 0.0001]. Both length and width of color Doppler mapping in the left anterior descending coronary artery increased after SHU 508A injection (from 5.75 +/- 5.32 and 1.51 +/- 1.17 to 17.04 +/- 8.76 and 4.21 +/- 1.78 mm, respectively, mean +/- SD, p < 0.0001).. The feasibility and quality of recording coronary blood flow velocity by transesophageal Doppler echocardiography are considerably improved by intravenous injection of SHU 508A. The improved feasibility of this new semi-invasive method for evaluating coronary blood flow velocity and flow reserve can considerably increase its research and clinical utilization.

Topics: Aged; Blood Flow Velocity; Contrast Media; Coronary Circulation; Coronary Vessels; Echocardiography, Transesophageal; Female; Heart Diseases; Humans; Image Enhancement; Injections, Intravenous; Male; Middle Aged; Polysaccharides