Abstract
In patients with suspected myocardial ischemia and non-diagnostic ECG contrast agents are recommended in all technically difficult ICU and ED patients to more quickly and accurately diagnose potentially life-threatening conditions and to reduce the need for downstream diagnostic testing. This chapter is aligned to the Clinical practice of contrast echocardiography: recommendation by the European Association of Cardiovascular Imaging (EACVI) 2017 and the 2018 American Society of Echocardiography Focused Update Regarding Clinical Applications of Ultrasonic Enhancing Agents in Echocardiography and gives advice how to use contrast agents in patients with acute coronary syndroms.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Agricola E, Slavich M, Bertoglio L, et al. he role of contrast enhanced transesophageal echocardiography in the diagnosis and in the orphological and functional characterization of acute aortic syndromes. Int J Cardiovasc Imaging. 2014;30:31–8.
Agricola E, Slavich M Rinaldi E, et al. Usefulness of contrast-enhanced transoesophageal echocardiography to guide thoracic endovascular aortic repair procedure. Eur Heart J Cardiovasc Imaging. 2016;17:67–75.
Bagur R, Bernier M, Kandzari DE, et al. A novel application of contrast echocardiography to exclude active coronary perforation bleeding in patients with pericardial effusion. Catheter Cardiovasc Interv. 2013;82:221–9.
Escabí-Mendoza JE, Martínez-Díaz JD, Avilés-Rivera ED. Perflutren microspheres for contrast echocardiography in a bloody pericardiocentesis. Tex Heart Inst J. 2006;33:214–7.
Evangelista A, Avegliano G, Aguilar R, Cuellar H, Igual A, González-Alujas T, Rodríguez-Palomares J, Mahia P, García-Dorado D. Impact of contrast-enhanced echocardiography on the diagnostic algorithm of acute aortic dissection. Eur Heart J. 2010;31(4):472–9.
Galiuto L, et al. The extent of microvascular damage during myocardial contrast echocardiography is superior to other known indexes of post-infarct reperfusion in predicting left ventricular remodeling. Results of the multicenter AMICI study. J Am Coll Cardiol. 2008;51:52–9.
Lancellotti P, et al. The use of echocardiography in acute cardiovascular care: Recommendations of the European Association of Cardiovascular Imaging and the Acute Cardiovascular Care Association. Eur Heart J Cardiovasc Imaging. 2015;16:119–46.
Main ML, et al. Acute mortality in hospitalized patients undergoing echocardiography with and without an ultrasound contrast agent (multicenter registry results in 4,300,966 consecutive patients). Am J Cardiol. 2008;102:1742–6.
Main ML, et al. Acute mortality in critical ill patients undergoing echocardiography with or without an ultrasound contrast agent. J Am Coll Cardiol Img. 2014;7:40–8.
Neskovic AN, et al. Emergency echocardiography; the European Association of Cardiovascular Imaging recommendations. Eur Heart J Cardiovasc Imaging. 2013;14:1–14.
Pope J, et al. Clinical features of emergency department patients with symptoms of acute cardiac ischemia, ACI-TIPI mulicenter trial. J Thromb Thrombolysis. 1998;6:63–74.
Pope J, et al. Missed diagnoses of cardiac ischemia in the emergency department. N Engl J Med. 2000;342:1163–70.
Porter TR, Mulvagh SL, Abdelmoneim SS, Becher H, Belcik JT, Bierig M, Choy J, Gaibazzi N, Gillam LD, Janardhanan R, Kutty S, Leong-Poi H, Lindner JR, Main ML, Mathias W Jr, Park MM, Senior R, Villanueva F. Clinical applications of ultrasonic enhancing agents in echocardiography: 2018 American Society of Echocardiography Guidelines Update. J Am Soc Echocardiogr. 2018;31(3):241–74.
Rinkevich D, et al. Regional left ventricular perfusion and function in patients presenting to the emergency department with chest pain and no ST-segment elevation. Eur Heart J. 2005;26:1606–11.
Roffi M, Patrono C, Collet J-P, Mueller C, Valgimigli M, Andreotti F, Bax JJ, Borger MA, Brotons C, Chew DP, Gencer B, Hasenfuss G, Kjeldsen K, Lancellotti P, Landmesser U, Mehilli J, Mukherjee D, Storey RF, Windecker S, ESC Scientific Document Group. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016;37(3):267–315. https://doi.org/10.1093/eurheartj/ehv320.
Sehmi JS, West C, Khattar R, Senior R, Chahal NS. Mass confusion: defining aortic pathology with ultrasound contrast. Circulation. 2015;132(15):1433–4.
Senior R, Becher H, Monaghan M, Agati L, Zamorano J, Vanoverschelde JL, Nihoyannopoulos P, Edvardsen T, Lancelloti P. Clinical practice of contrast echocardiography: recommendation by the European association of cardiovascular imaging (EACVI). Eur Heart J Cardiovasc Image. 2017;18(11):1205.
Thygesen K, et al. Third universal definition of myocardial infarction. Eur Heart J. 2012;33:2552–67.
Wei K, et al. A predictive instrument using contrast echocardiography in patients presenting to the emergency department with chest pain and without ST-segment elevation. J Am Soc Echocardiogr. 2010;23:636–42.
Author information
Authors and Affiliations
7.1 Electronic Supplementary Material
Dilated hypokinetic LV on 2D echocardiography suggesting dilated cardiomyopathy, end-diastolic LV volume exceeding 300 mL, secondary mitral regurgitation (WMV 882 kb)
Myocardial contrast echocardiography at rest, lack of myocardial opacification apical lateral and apical anterior indicating a perfusion defect (WMV 303 kb)
Myocardial contrast echocardiography at rest, lack of myocardial opacification apical lateral and apical anterior indicating a perfusion defect (WMV 325 kb)
Stunned myocardium after apical STEMI (left), the apical myocardium is akinetic but opacified; ‘no reflow’ despite successful recanalization of the epicardial LAD (right), the apical myocardium is akinetic and has a perfusion defect at rest (AVI 16244 kb)
Stunned myocardium after apical STEMI (left), the apical myocardium is akinetic but opacified; ‘no reflow’ despite successful recanalization of the epicardial LAD (right), the apical myocardium is akinetic and has a perfusion defect at rest (AVI 9101 kb)
Longitudinal strain, 4-, 2- und 3-chamber view 7 days after anterior. Dyskinetic apical-anterior segment, and akinetic mid anterior, apical septal, mid anteroseptal, apical lateral und mid anterolateral segments (16-segment-modell) (WMV 723 kb)
The myocardial segments with microvascular obstruction (no reflow) are highlighted by the red line. These segments appear dark compared to opacified basal inferoseptal, basal inferior und mid inferior segments (WMV 1116 kb)
Pericardial effusion around the LV apex, contrast agent in the effusion (yellow arrows) (AVI 19045 kb)
TEE performed in a patient in whom coronary perforation was suspected, transgastric short axis view. The recording before injection (top) of the contrast agent shows a pleural and a pericardial effusion with a hematoma (*). The echogenicity of the hematoma resembles to that of liver tissue. After injection of the contrast agent (bottom) the LV cavity is opacified, but no contrast is displayed in the pericardial effusion. This finding excludes ongoing bleeding (AVI 20674 kb)
TEE performed in a patient in whom coronary perforation was suspected, transgastric short axis view. The recording before injection (top) of the contrast agent shows a pleural and a pericardial effusion with a hematoma (*). The echogenicity of the hematoma resembles to that of liver tissue. After injection of the contrast agent (bottom) the LV cavity is opacified, but no contrast is displayed in the pericardial effusion. This finding excludes ongoing bleeding (AVI 83684 kb)
TEE, contrast bubbles in the pericardial effusion (transgastric modified long axis, left) in a patient with posterior aortic root rupture during transcutaneous aortic valve implantation. The posterior aortic root was not well visualized. After injection and 0,2 mL Luminity® multiple bright echo spots are found anterior to the RV indicating ongoing bleeding from the rupture. Because of the contrast echocardiography findings the patient was referred to a thoracic CT which showed hematoma caused by posterior aortic root rupture (AVI 28717 kb)
TEE, contrast bubbles in the left sided pleural effusion (mid esophageal position of the probe directed towards the descending aorta, right) in a patient with posterior aortic root rupture during transcutaneous aortic valve implantation. The posterior aortic root was not well visualized. After injection and 0.2 mL Luminity® multiple bright echo spots are found in the left sided pleural effusion indicating ongoing bleeding from the rupture. Because of the contrast echocardiography findings the patient was referred to a thoracic CT which showed hematoma caused by posterior aortic root rupture (AVI 12832 kb)
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Becher, H., Helfen, A. (2019). Acute Coronary Syndrome (ACS). In: Contrast Echocardiography. Springer, Cham. https://doi.org/10.1007/978-3-030-15962-7_7
Download citation
DOI: https://doi.org/10.1007/978-3-030-15962-7_7
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-15961-0
Online ISBN: 978-3-030-15962-7
eBook Packages: MedicineMedicine (R0)