Abstract
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 %lt; 0.001) improvement of the average end-diastolic scores of the septal, apical and lateral regions (1.4 %plusmn; 0.5, 0.6 %plusmn; 0.7 and 0.9 %plusmn; 0.5 before and 1.8 %plusmn; 0.4, 1.4 %plusmn; 0.6 and 1.7 %plusmn; 0.5 after Levovist). The average end-systolic score was significantly different (p %lt; 0.001) from end-diastolic values in the apex only (0.3 %plusmn; 0.6 before and 0.8 %plusmn; 0.7 after Levovist). Average apical scores using color Doppler improved from 0.3 %plusmn; 0.6 and 0.1 %plusmn; 0.2 during end-diastole and end-systole to 1.7 %plusmn; 0.5 and 1.2 %plusmn; 0.6, respectively, after Levovist (p %lt; 0.001); the average end-diastolic contrast-enhanced color Doppler score was significantly higher than the corresponding grey scale score (p %lt; 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.
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von Bibra H, Becher H, Firschke C, Schlief R, Emslander HP, Schömig A. Enhancement of mitral regurgitation and normal left atrial color Doppler flow signals with peripheral venous injection of a saccharide-based contrast agent. J Am Coll Cardiol 1993; 22: 521-8.
von Bibra H, Sutherland G, Becher H, Neudert J, Nihoyannopoulos P. Clinical evaluation of left heart Doppler contrast enhancement by a saccharide-based transpulmonary contrast agent. J Am Coll Cardiol 1995; 25(2): 500-8.
Schlief R, Schürmann R, Balzer T, Zomack M, Niendorf HP. Saccharide based contrast agents. In: Nanda NC, Schlief R, (eds). Advances in echo imaging using contrast enhancement. Amsterdam: Kluwer, 1993: 71-96.
Weyman AE. Doppler instrumentation. In: Weyman AE, (ed). Principles and practice of echocardiography. Philadelphia: Lea & Febinger, 1994: 163-200.
von Bibra H, Stempfle H, Poll A, Schlief R, Blömer H. Echocontrast agents improve flow display of color Doppler-in vitro studies. Echocardiography 1991; 8: 533-40.
Crouse L, Cheirif J, Hanly D, Kisslo J, Labovitz A, Raichlen J, Schutz R, Shah P, Smith M. Opacification and border delineation improvement in patients with suboptimal endocardial border definition in routine echocardiography: results of the phase III albunex multicenter trial. J Am Coll Cardiol 1993; 22: 1494-1500.
Schlief R, Staks T, Mahler M, Rufer M, Fritzsch T, Seifer W. Successful opacification of the left heart chambers on echocardiographic examination after intravenous injection of a new saccharide-based contrast agent. Echocardiography 1990: 7-14.
Schröder K, Agrawal R, Völler H, Schlief R, Schröder R. Improvement of endocardial border delineation in suboptimal stress-echocardiograms using the new left heart contrast agent SHU 508 A. Int J Card Imaging 1994; 10(1): 45-51.
Mor-Avi V, Robinson K, Shroff S, Lang RM. Stability of albunex microspheres under ultrasonic irradiation: an in vitro study. J Am Soc Echocardiogr 1994; 7: S29.
Vandenberg BF, Melton HE. Acoustic lability of albumin microspheres. J Am Soc Echocardiogr 1994; 7: 582-9.
Rehbach K, Dennig K, Rudolf W. Echokardiographie mit lungengängigem Kontrastmittel: Einflußvon Ultraschallfrequenz und Kontrastmenge auf die Opazifizierung des linken Ventrikels. Z Kardiol 1992; 81Suppl 3: 28.
Wei K, Skyba D, Firschke C, Lindner JR, Kaul S. Why are bubbles destroyed by ultrasound? Circulation 1996; Suppl I 94–8: 141.
Schrope B, Newhouse VL, Uhlendorf V. Simulated capillary blood flow measurement using a nonlinear ultrasonic contrast agent. Ultrasonic Imag 1992; 14: 134-58.
Porter TR, Xie F. Transient myocardial contrast following initial exposure to diagnostic ultrasound pressures with minute doses of intravenously injected microbubbles: demonstration and potential mechanisms. Circulation 1995; 92: 2391-5.
Firschke C, Lindner JR, Wei K, Goodman NC, Kaul S. Detection of coronary stenoses using venous injection of FS-069 with intermittent harmonic imaging. J Am Soc Echocardiogr 1996; 9(3): 362.
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Firschke, C., Köberl, B., von Bibra, H. et al. Combined use of contrast-enhanced 2-dimensional and color Doppler echocardiography for improved left ventricular endocardial border delineation using Levovist, a new venous echocardiographic contrast agent. Int J Cardiovasc Imaging 13, 137–144 (1997). https://doi.org/10.1023/A:1005739213507
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DOI: https://doi.org/10.1023/A:1005739213507