Kaul_subbedcardio.qxp 20/4/09 2:54 pm Page 12
Imaging
Table 1: Ultrasound Contrast Agents
Name Manufacturer Shell Gas Diameter (µm) Concentration (ml
-1
) Comments
Levovist Schering None—stabilised Air 1.2 1.2–2·10
8
when Available for cardiological
with 0.1% palmitate 2.5g is dissolved applications in 69 countries
in 10ml saline. but not in the US
Albunex Molecular Biosystems, Inc. Denatured human Air 4.3 0.5·10
9
Approved for LV cavity
albumin opacification in the US, but no
longer manufactured
Imagent Alliance Pharamceuticals/ Surfactant-coated Perfluorohexane 5.0 0.5·10
8
Approved for LV cavity
IMCOR opacification in the US, but
no longer manufactured
Optison General Electric Denatured human Perflutren 3.0–4.5 5.0–8.0·10
8
Approved for LV cavity
albumin opacification in the US,
Europe, and Latin America
Sonazoid General Electric Lipid Perflubutane 2.4–2.5 0.3·10
9
Approved in Japan for liver
opacification
Definity Lantheus Medical Imaging Lipid Octafluropropane 1.1–3.3 1.2·10
10
Approved for rest echo LV cavity
opacification in the US, Europe,
Canada, Australia, and some
countries in Latin America, Asia,
and the Middle East; for radiology
applications in Canada, Mexico, and
Australia; and for stress echo in the
EU and Mexico
Sonovue Bracco Diagnostics Lipid Sulphur 2.5 5.0·10
8
Available in Europe for LV cavity
hexafluoride opacification and radiological
applications
Cardio-sphere Point Biomedical, Inc. Bilayer: inner Nitrogen 3.0 2.0–5.0·10
8
Development terminated for
polymer and financial reasons
outer albumin
Imagify Acusphere, Inc. Polymer Decafluorobutane 2.3 Gas is 260±25µg·ml
-1
Under FDA review for myocardial
of reconstituted product perfusion
FDA = US Food and Drug Administration.
Figure 5: Echocardiographic Images Before and After the
in a patient with apical hypertrophic cardiomyopathy. The endocardium was
Administration of Ultrasound Contrast in a Patient with not clearly defined in the non-contrast-enhanced images, while after the
Apical Hypertrophic Cardiomyopathy
administration of contrast better endocardial definition led to the accurate
diagnosis of the condition.
AB
The incidence of non-compaction of the LV has also markedly
increased with the use of US contrast agents, since it is much easier
to visualize the thinner LV wall and the myocardial indentations and
crevices seen in this condition.
25
All patients with muscular dystrophy
being referred to our laboratory to rule out cardiac involvement
receive US contrast to rule out non-compaction or other
abnormalities. The endocardium is not clearly seen in many patients
with apical aneurysms or pseudo-aneurysms. US contrast can help
physicians to make the correct diagnosis and begin an appropriate
therapy.
26
There also have been reports of the diagnosis of cardiac
rupture with the use of US contrast agents.
27
One of the biggest clinical applications for CE is stress
The endocardium was not clearly defined in the non-contrast-enhanced images (A), while
echocardiography, where visualization of every myocardial segment
after administration of contrast (B) better endocardial definition led to the accurate diagnosis during stress is crucial to make the diagnosis of coronary artery
of the condition.
disease (CAD).
28,29
In many cases the endocardium may be vizualised
hypertrophic cardiomyopathy, since in many patients with this condition the during rest and not during stress. Consequently, in our laboratory all
endocardium is not well visualized.
24
Figure 5 illustrates echocardiographic patients are required to undergo CE during stress unless there is a
images before (panel A) and after (panel B) the administration of US contrast specific contraindication or if the patient declines. Our exercise stress
12 US CARDIOLOGY
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