Tips and Tricks in Contrast Echocardiography
Transcript of Tips and Tricks in Contrast Echocardiography
Tips and Tricks in Contrast
Echocardiography
Roxy Senior
Professor of Cardiology
Royal Brompton Hospital London
Imperial College London
Summary of Main Recommendations by
EACVI-2017
• Contrast must be used if >=2seg not visualised
• To better assess structural abnormalities especially apical
• In SE even if all segments visualised at rest if images deteriorate
during deep inspiration contrast must be used
• Myocardial perfusion assessment is recommended in SE if
expertise exist
R.Senior et al Eur Heart J – Cardiovasc Imaging 2017; 18: 1205
76yr woman admitted to ITU with
worsening COVID 19 Pneumonia
haemodynamic
instability.
Recurrent arrhythmia
↑Trop I,D-Dimer,BNP
Echo requested to
assess LV
function,RWMA.
Contrast Echo
71 yr male admitted in HDU with Respiratory Failure
H/o of heart failure
↑Trop I,BNP,D-Dimer
Echo requested to
assess cardiac
function
Contrast Echo
• 29-year-old obese Asian female
• Atypical chest pain
• Diabetic for 2 years
• Normal resting ECG
Ex Echo
Dwivedi and Senior.. Brit Med J. 2006:332:643.
61 yr male with atypical angina -EXEcho
Relation between Transmit Power(MI), tissue
and microbubble response
Microbubble Tissue
1.0
0.5
<0.2
0
Implosion Harmonic ++
Harmonics ++ Harmonics+
Harmonics weak
Fundamental strong
Harmonic weak
Fundamental strong
Power(MI)
MI
• Better Tissue cancellation
• Better signal to noise ratio
• More uniform LV opacification as contrast is not
destroyed
• Less amount of contrast used
• Perfusion of myocardial walls and masses can be
assessed simultaneously with wall motion
Low MI-Contrast Specific Imaging(multipulse)
Optimal Image Acquisition
Homogenous opacificationClear visualisation of endo/epicardiumAppreciation of wall thickeningNo basal attenuation or apical artifact
Attenuation artifact
Bloooming artifact
Other types of attenuation artifacts
Senior et al AHJ 1998:
Swirling
Excessive bubble destruction in the near field (apex) that may
be due to a combination of factors:
high MI-int MI,
insufficient contrast administration or severe LV dysfunction
with sluggish flow at the apex.
Overcoming Swirling
Decrease the mechanical index-always use low MI contrast
specific setting,
increase contrast dose,
Perfusion Imaging
Take Home message
• Use low MI Contrast specific imaging option
• Slow bolus
• Obtain uniform LV opacification with some myocardial
opacification
• Optimum gain and keep focus at the mitral valve level but
move towards apex if there is apical artifact