ICUS Weekly News Monitor 9-29-17

European Society of Cardiology

European Heart Journal - Cardiovascular Imaging(2017) 0, 1-33

Doi: 10.1093/ehjci/jex182

Clinical practice of contrast echocardiography: recommendation by the European Association of Cardiovascular Imaging (EACVI) 2017

Authors:  Roxy Senior1*, Harald Becher2, Mark Monaghan3, Luciano Agati4, Jose Zamorano5, Jean Louis Vanoverschelde6, Petros Nihoyannopoulos7, Thor Edvardsen8, and Patrizio Lancellotti9

1Department of Cardiology, Royal Brompton Hospital, Imperial College, Sydney Street, London SW3 6NP, UK; 2Alberta Heart Institute, Edmonton, Canada; 3King’s College Hospital, London, UK; 4La Sapienza University, Rome, Italy; 5CIBERCV, University Hospital Ramon y Cajal, Madrid, Spain; 6Cliniques Universitaires St-Luc, Universite´ Catholique de Louvain, Brussels, Belgium; 7Hammersmith Hospital, Imperial College, London, UK; 8Oslo University Hospital and University of Oslo, Norway; and 9University of Liege Hospital, GIGA Cardiovascular Science, Heart Valve Clinic, Imaging Cardiology, Liege, Belgium

September 30, 2017

Excerpt:

Page 10: Contrast 2D echocardiography should be considered irrespective of image quality when clinical management depends on accurate measurements of LVEF such as monitoring of patients treated withcardiotoxic drugs and when implantation of ICD or CRT devices are considered (Class IIa, Level B).

It has been shown that contrast echocardiography improved confidence of the interpretation of regional LV wall motion and increased the inter-observer agreement from 80% (non-contrast tissue harmonic imaging) to 95% (2D contrast echocardiography) in intensive care unit patients.

They found an increased reproducibility of wall motion score index using contrast 2D echocardiography and that 55% of the patients were reclassified with motion abnormalities by contrast analysis. In patients 7–10 days after acute MI assessment of LV ESV and EF by contrast echocardiography showed incremental prognostic value for predicting hard events beyond clinical and non-contrast determined LV function.

 
 
 
 
 
 

European Society of Cardiology

European Heart Journal - Acute Cardiovascular Care

DOI: 10.1177/2048872617728559;  journals.sagepub.com/home/acc

Therapeutic application of contrast ultrasound in ST elevation myocardial infarction: Role in coronary thrombosis and microvascular obstruction

Authors:  Jeroen Slikkerveer1,2, Lynda JM Juffermans1,2,3, Niels van Royen1,2, Yolande Appelman1,2, Thomas R Porter4 and Otto Kamp1,2

1 Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands; 2 Institute of Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands; 3 Department of Physiology, VU University Medical Center, Amsterdam, The Netherlands, 4University of Nebraska Medical Center, Omaha, Nebraska, USA

Corresponding author:  Jeroen Slikkerveer, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands;  Email: This email address is being protected from spambots. You need JavaScript enabled to view it. This email address is being protected from spambots. You need JavaScript enabled to view it.

September 30, 2017

Abstract

In the past few decades, cardiac ultrasound has become a widely available, easy-to-use diagnostic tool in many scenarios in acute cardiac care. The introduction of microbubbles extended its diagnostic value. Not long thereafter, several investigators explored the therapeutic potential of contrast ultrasound on thrombus dissolution. Despite large improvements in therapeutic options, acute ST elevation myocardial infarction remains one of the main causes of mortality and morbidity in the western world. The therapeutic effect of contrast ultrasound on thrombus dissolution might prove to be a new, effective treatment strategy in this group of patients. With the recent publication of human studies scrutinising the therapeutic options of ultrasound and microbubbles in ST elevation myocardial infarction, we have entered a new stage in this area of research. This therapeutic effect is based on biochemical effects both at macrovascular and microvascular levels, of which the exact working mechanisms remain to be elucidated in full. This review will give an up-to-date summary of our current knowledge of the therapeutic effects of contrast ultrasound and its potential application in the field of ST elevation myocardial infarction, along with its future developments.

 
 
 
 
 
 

Health Imaging

Microbubble ultrasound, perfusion software combine to check ablation of liver lesions

By Dave Pearson

September 26, 2017

Following percutaneous interventions for malignant liver lesions, patients are ably assessed with a combination of contrast-enhanced ultrasound (CEUS) and perfusion-imaging software, according to the authors of a study published online September 25 in Ultraschall in der Medizin/European Journal of Ultrasound.

Radiologists and internists at the University of Regensburg in Germany reviewed the cases of 88 patients who had been treated with percutaneous ablation of 165 malignant liver lesions (108 hepatocellular carcinomas and 57 metastases).

Post-treatment, the patients were injected with sulfur hexafluoride microbubbles and imaged with ultrasound.

They were again assessed up to six months later, this time with contrast-enhanced CT or MRI.

Using commercially available perfusion software (Bracco’s VueBox), the researchers found “significant differences in all cases between the center compared to the margins for the main perfusion parameters,” lead author Isabel Wiesinger, MD, and colleagues report.

Further, all parameters—peak, wash-in and wash-out ratios alongside type of lesion and method of ablation—were significantly different between lesions treated successfully vs. those with recurrence, they write.

“A combination of CEUS with perfusion imaging enables critical assessment of successful treatment after percutaneous interventional procedures for a malignant liver lesion,” the authors conclude.

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