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Contrast echocardiography for detection of myocardial perfusion abnormalities

A clinical perspective

Kontrastechokardiographie zur Erkennung von Auffälligkeiten der Myokardperfusion

Eine klinische Sichtweise

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Abstract

Myocardial contrast echocardiography (MCE) is a well-established imaging technique in the assessment of patients with known or suspected coronary artery disease. The use of ultrasound contrast agents has optimized the evaluation of left ventricular function and, moreover, permits simultaneous assessment of the myocardial perfusion. This technique utilizes microbubbles that remain in the intravascular space and the contrast intensity reflects the concentration of the microbubbles in the myocardium. A homogeneous opacification of the myocardium after destruction of the microbubbles during high-power imaging is regarded as normal perfusion and absence of CAD. If the replenishment rate is reduced, this is suggestive of significant CAD. In comparison with other techniques, MCE shows comparable sensitivity, specificity, and diagnostic accuracy while it is an easy-to-perform bedside technique that can be a valuable tool for the clinician.

Zusammenfassung

Die Myokardkontrastechokardiographie (MCE) ist ein wohletabliertes bildgebendes Verfahren zur Untersuchung von Patienten mit bekannter koronarer Herzkrankheit (KHK) oder dem Verdacht darauf. Die Verwendung von Ultraschallkontrastmitteln hat zur Optimierung der Beurteilung der linksventrikulären Funktion geführt und ermöglicht außerdem die gleichzeitige Einschätzung der Myokardperfusion. Bei diesem Verfahren werden Mikrobläschen verwendet, die im Intravaskulärraum bleiben; die Kontrastintensität spiegelt die Konzentration der Mikrobläschen im Myokard wider. Eine homogene Trübung des Myokards nach Zerstörung der Mikrobläschen während der Untersuchung mittels Hochleistungsbildgebung gilt als normale Perfusion ohne Anhalt für eine KHK. Wenn die Wiederauffüllungsrate vermindert ist, gilt das als Hinweis auf eine erhebliche KHK. Im Vergleich zu anderen Verfahren weist die MCE eine vergleichbare Sensitivität, Spezifität und diagnostische Genauigkeit auf und ist dabei eine leicht am Krankenbett durchzuführende Technik, die ein wertvolles Werkzeug für den Kliniker darstellen kann.

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  1. Department of Echocardiography, Royal Brompton Hospital, Sydney Street, SW3 6NP, London, UK

    R. Senior

  2. Department of Cardiovascular Medicine, Northwick Park Hospital, Harrow, UK

    N. Karogiannis &  R. Senior

  3. National Heart and Lung Institute, Imperial College, London, UK

    R. Senior

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N. Karogiannis has no competing interests. R. Senior received speaker fees from Bracco, Milan, Italy Philips Healthcare, Eindhoven, Holland and Lantheus Medical Imaging, Boston, USA.

This article does not contain any studies with human participants or animals performed by any of the authors.

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Karogiannis, N., Senior, R. Contrast echocardiography for detection of myocardial perfusion abnormalities. Herz 42, 287–294 (2017). https://doi.org/10.1007/s00059-017-4536-7

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