Safety of dobutamine stress real-time myocardial contrast echocardiography

Tsutsui, Jeane Mike; Elhendy, Abdou; Xie, Feng; O’Leary, Edward; McGrain, Anna C.; Porter, Thomas R.

doi:10.1016/j.jacc.2005.01.024

Cited by 96 publications

(78 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…23 In general, tissue retention and adherence to injured endothelium seems to be more characteristic of albumin-coated microbubbles than lipid-encapsulated microspheres. 24 An excellent safety profile has been generated for Definity™ in studies of patients with compromised vascular beds including coronary stenosis, 25 carotid stenosis, 26 and renal vascular disease. 27 Similarly, in our patient, we did not observe any untoward effects following the injection of the contrast agent.…”

Section: Discussionmentioning

confidence: 99%

Case report: Optimizing intraoperative detection of pulmonary embolism using contrast-enhanced echocardiography

Izrailtyan

Clark

Swaminathan

et al. 2006

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

Purpose: Perioperative pulmonary embolism (PE) is associated with significant morbidity and mortality. Intraoperatively, the clinical management of patients with PE can be enhanced by the use of transesophageal echocardiography (TEE) to visualize emboli, assess pulmonary artery (PA) anatomy, and monitor the function of the right ventricle. However, the sensitivity of intraoperative TEE to detect thromboemboli is reported to be below 50%. In this report, we describe the use of contrastenhanced TEE (CE-TEE) to improve the visualization of PE. Clinical features:A 44-yr-old female with chronic thromboembolic pulmonary hypertension was scheduled for pulmonary thromboendarterectomy. The precardiopulmonary bypass TEE exam demonstrated signs of PA obstruction and right ventricle dysfunction, but the borders of the thrombus in the right PA were only minimally visualized. Perflutren lipid microspheres, composed of octafluoropropane encapsulated in an outer lipid shell, were injected as a 0.3 mL iv bolus, while visualizing the right PA with harmonic ultrasound imaging. The CE-TEE image clearly visualized a large mobile thrombus along with a distinct pattern consistent with pulmonary flow obstruction. The postcardiopulmonary bypass CE-TEE confirmed thrombus evacuation and absence of PA flow abnormalities. Conclusion:Contrast-enhanced-TEE may decrease operator dependency and increase the sensitivity necessary to detect central, surgically accessible PE.

show abstract

Section: Discussionmentioning

confidence: 99%

Case report: Optimizing intraoperative detection of pulmonary embolism using contrast-enhanced echocardiography

Izrailtyan

Clark

Swaminathan

et al. 2006

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

show abstract

“…MCPI was considered diagnostic for CAD in the presence of reversible perfusion abnormalities. The feasibility for interpretation of stress MCPI in our laboratory is 96% for LAD distribution, 95% for RCA distribution, and 94% for LCx distribution (38).…”

Section: Echocardiographic Imagingmentioning

confidence: 93%

Noninvasive Diagnosis of Coronary Artery Disease in Patients With Diabetes by Dobutamine Stress Real-Time Myocardial Contrast Perfusion Imaging

et al. 2005

Self Cite

View full text Add to dashboard Cite

OBJECTIVE -The aim of this study was to assess the accuracy of real-time myocardial contrast perfusion imaging (MCPI) during dobutamine stress in the diagnosis and localization of coronary artery disease (CAD) in patients with diabetes. Myocardial contrast echocardiography is a new technique that allows evaluation of myocardial perfusion. Its utility in diabetic patients has not been defined. RESEARCH DESIGN AND METHODS-Dobutamine-atropine stress test was performed in conjunction with MCPI using Optison or Definity at rest and at peak stress in 128 patients with diabetes and suspected CAD who underwent coronary angiography within 1 month. CAD was defined as Ն50% stenosis in one or more coronary artery. MCPI was considered diagnostic of CAD in the presence of reversible perfusion abnormalities. The normalcy rate of MCPI was additionally determined in 18 asymptomatic nondiabetic patients with low probability.RESULTS -CAD was detected in 101 (79%) patients by angiography. Reversible perfusion abnormalities were detected in 90 patients with and 13 patients without CAD. The overall sensitivity of MCPI was 89% (95% CI 83-95), specificity 52% (33-71), and accuracy 81% (75-88). Reversible abnormalities were detected in two or more vascular distributions in 44 of 56 patients with multivessel CAD and in 8 of 63 patients without (sensitivity 68%, specificity 87%, positive predictive value 84%, and accuracy 79%). Regional sensitivity was 75% (65-85) for left anterior descending CAD, 71% (60 -83) for left circumflex, and 67% (55-78) for right CAD. MCPI was normal in 16 of the 18 patients with low clinical probability of CAD (normalcy rate 89%).CONCLUSIONS -MCPI is a useful noninvasive technique for the diagnosis and localization of CAD in diabetic patients. The extent of perfusion abnormalities can identify patients with multivessel CAD with a moderate sensitivity and high specificity. Diabetes Care 28:1662-1667, 2005C oronary artery disease (CAD) is a leading cause of morbidity and mortality in patients with diabetes (1-5). Among patients with CAD, diabetes is associated with a worse prognosis (6 -8). Angiographic studies have shown that patients with diabetes have more advanced CAD at the time of the diagnosis. Although coronary angiography remains the gold standard, the expense and risk associated with this procedure prohibit its routine use for diagnosis of CAD.Various noninvasive stress imaging modalities are currently available for the evaluation of CAD in diabetic patients (10 -23). However, there are scarce data regarding the ability of noninvasive imaging techniques to identify multivessel CAD based on abnormalities in multivascular regions. This information is important since the extent of CAD determines the outcome, as well as potential benefit, of revascularization (24,25). Dobutamine stress echocardiography (DSE) has been reported as a safe method for evaluation of CAD in diabetic patients (23). Nevertheless, there are limited data regarding the diagnostic accuracy of this technique. Previous studies included in...

show abstract

“…Although the safety profile of commercially available lipid-encapsulated microbubbles has already been demonstrated in humans (30), the bioeffect of such a prolonged exposure to ultrasound has not been previously reported. Further studies are still necessary to address this issue.…”

Section: Limitationsmentioning

confidence: 98%

Bioeffects of albumin-encapsulated microbubbles and real-time myocardial contrast echocardiography in an experimental canine model

Dourado

Tsutsui

Santos

et al. 2006

Braz J Med Biol Res

View full text Add to dashboard Cite

Myocardial contrast echocardiography has been used for assessing myocardial perfusion. Some concerns regarding its safety still remain, mainly regarding the induction of microvascular alterations. We sought to determine the bioeffects of microbubbles and real-time myocardial contrast echocardiography (RTMCE) in a closed-chest canine model. Eighteen mongrel dogs were randomly assigned to two groups. Nine were submitted to continuous intravenous infusion of perfluorocarbon-exposed sonicated dextrose albumin (PESDA) plus continuous imaging using power pulse inversion RTMCE for 180 min, associated with manually deflagrated high-mechanical index impulses. The control group consisted of 3 dogs submitted to continuous imaging using RTMCE without PESDA, 3 dogs received PESDA alone, and 3 dogs were sham-operated. Hemodynamics and cardiac rhythm were monitored continuously. Histological analysis was performed on cardiac and pulmonary tissues. No hemodynamic changes or cardiac arrhythmias were observed in any group. Normal left ventricular ejection fraction and myocardial perfusion were maintained throughout the protocol. Frequency of mild and focal microhemorrhage areas in myocardial and pulmonary tissue was similar in PESDA plus RTMCE and control groups. The percentages of positive microscopical fields in the myocardium were 0.4 and 0.7% (P = NS) in the PESDA plus RTMCE and control groups, respectively, and in the lungs they were 2.1 and 1.1%, respectively (P = NS). In this canine model, myocardial perfusion imaging obtained with PESDA and RTMCE was safe, with no alteration in cardiac rhythm or left ventricular function. Mild and focal myocardial and pulmonary microhemorrhages were observed in both groups, and may be attributed to surgical tissue manipulation.

show abstract

Safety of dobutamine stress real-time myocardial contrast echocardiography

Abstract: Dobutamine stress RTCE appears to be a safe and feasible technique for evaluating patients with known or suspected CAD.

Cited by 96 publications

References 27 publications

Case report: Optimizing intraoperative detection of pulmonary embolism using contrast-enhanced echocardiography

Case report: Optimizing intraoperative detection of pulmonary embolism using contrast-enhanced echocardiography

Noninvasive Diagnosis of Coronary Artery Disease in Patients With Diabetes by Dobutamine Stress Real-Time Myocardial Contrast Perfusion Imaging

Bioeffects of albumin-encapsulated microbubbles and real-time myocardial contrast echocardiography in an experimental canine model

Contact Info

Product

Resources

About