P470Application of real-time contrast echocardiography for the assessment of morphology, function and perfusion of right ventricle.


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Abstract

Background: The proper echocardiographic evaluation of morphology and function of right ventricle (RV) still remains difficult. Contrast-enhanced echocardiography (CE) improves accuracy of standard transthoracic echocardiography and is recommended for quantitative assessment of left ventricle (LV). To our knowledge CE has not been used in evaluation of RV.Aim: to apply CE for the assessment of RV performance among patients with pulmonary hypertension (PH).Methods: Real time CE was performed among 23 patients with PH: 13 patients with acute pulmonary embolism with RV dysfunction (PE) and 13 patients with pulmonary hypertension due to chronic thrombo-embolism and pulmonary arterial hypertension. SonoView contrast agent was administered as a slow iv bolus (1 ml) through the peripheral vein followed by slow saline flush. Both RV opacification (RVO) and myocardial contrast echocardiography (MCE) of RV were done. CE was performed using a modality of real-time perfusion imaging with low mechanical index. CE study of RV was done with delay - after full opacificaton of LV. This modality permits to avoid the strongest first pass contrast intensity in RV. From apical 4-chamber view following parameters were assessed before and after contrast administration: RV end–diastolic area (RVEDA), RV end-systolic area (RVESA) and fractional area change (FAC). For perfusion evaluation RV lateral wall was divided into basal, mid and apical segments. Perfusion assessment was qualitative with standard visual method (two perfusion patterns: 1 – normal perfusion, 2 – perfusion defect) and quantitative using a Philips Q-LAB programme (ROI modality).Results: Although CE significantly improved visualisation of RV morphology in comparison to unenhanced images, RVEDA, RVESA and FAC assessed before and after contrast injection were comparable (RVEDA 24,6 ± 9,0 before vs 24,7 ± 10,2 cm2 after contrast injection, p=0,98; RVESA 17,9 ± 8,7 before vs 18,7 ± 9,6cm2 after contrast injection, p=0,8; FAC 29,6 ± 14,2 before vs 29,1 ± 13,0%; p=0,9). RV perfusion assessment with standard visual method revealed perfusion defect in 42 out of 78 analyzed segments (54%). There was linear correlation between perfusion and FAC (r = -0,47; p = 0,03). RV perfusion intensity calculated with Philips Q-LAB programme seems to be lower in PE group in comparison with other studied patients (ROI 11,3 ± 4,9 vs 13,0 ± 7,6 dB; p=0,4).Conclusion: Implemented protocol for RVO and MCE may be applied to RV assessment among patients with pulmonary hypertension. This preliminary findings need to be confirmed among larger population and patients with normal RV.

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