Kontrastekokardiografi
Reidar Winter Överläkare
Hjärtkliniken Karolinska Universitetssjukhuset
Professor i Medicinsk Teknik,
KTH - Kungliga Tekniska Högskolan, STH
Stockholm
Är det farligt att ge ultraljudskontrast?
Contra indications:
1.
2.
Significant intracardiac shunt
Known hypersensibilty to the agent
In acute conditions:
 Monitoring of vital signs for 30 minutes

Slutsatser avseende säkerhet:
• Samtliga tillgängliga ekokontrastmedel har extremt
god säkerhetsprofil
• Kontraindikationer:
– Överkänslighet mot den aktiva substansen eller mot något
hjälpämne.
– Pulmonell hypertension med ett systoliskt lungartärtryck
på > 90 mm Hg.
– Betydande intrakardiell shunt
Är det farligt att ge ultraljudskontrast?
 NEJ !
När och varför skall vi använda
kontrast?
Evidence-based recommendations
by
European Association of Echocardiography
EJE 2009;10:194-212
www.escardio.org/communities/EAE/publications/Pages/papers-interest.aspx
ä
ASE SYNOPSIS OF SUGGESTED APPLICATIONS FOR ULTRASOUND CONTRAST AGENT USE:
•
•
•
•
•
•
•
To enable improved endocardial visualization and assessment of left ventricular (LV)
structure and function when 2 contiguous segments are not seen on noncontrast images
To reduce variability and increase accuracy in LV volume and LV ejection fraction (LVEF)
measurements by 2-dimensional (2D) echocardiography
To increase the confidence of the interpreting physician in LV functional, structure, and
volume assessments
To confirm or exclude the echocardiographic diagnosis of the following LV structural
abnormalities, when nonenhanced images are suboptimal for definitive diagnosis

Apical variant of hypertrophic cardiomyopathy

Ventricular noncompaction

Apical thrombus

Complications of myocardial infarction, such as LV aneurysm, pseudoaneurysm, and
myocardial rupture
To assist in the detection and correct classification of intracardiac masses, including tumors
and thrombi
For echocardiographic imaging in the ICU when standard tissue harmonic imaging does not
provide adequate cardiac structural definition
To enhance Doppler signals when a clearly defined spectral profile is not visible and is
necessary to the evaluation of diastolic and/or valvular function
ASE consensus statement JASE 2008;21:1179–1201
Lite praktikaliteter,
fallgropar och artefakter
Administration;
infusion eller bolus?
Intravenöst
INFUSION
BOLUS
Intravenös inj/inf
INFUSION
BOLUS
Sonovue/NaCl 5/5 ml, 0.8-1.2ml/min
Sonovue 1-1.5 ml + 0.5 rep
Optison/NaCl 3/10 ml, 1-1.5 ml/min
Optison 0.5-1 ml + 0.3 rep
+/-
+/-
 Steady state intensitet
 ”Up and down”
 Kräver specialpump
 Kort duration
 Mer krävande administration
 Enklare att administrera
The impact of Mechanical Index (MI)
Destruktion av bubblor
MI +
1,2
0,3
Bra kantdetektion, men
destruktion i myokardiet
MI Synlig perfusion men nedsatt
penetration och kantdetektion
0.1
The impact of contrast dose (MI 0.15)
Sonovue Bolus:
0,25 ml
Ingen attenuering men apikal
”swirling” och dålig kantdetektion
Relativt god kantdetektion,
Ingen attenuering
0,5 ml
1 ml
Mycket skarp kantdetektion apikalt
och midventrikulärt, men lite
attenuation i basala VK
Impact of presets
Adult echo preset, Tissue Harmonics, MI 1.2
LVO preset, issue Harmonics, MI 0.2
Adult echo preset, Tissue Harmonics, MI 0.3
Low MI preset (power modulation), MI 0.1
Nyttan av dedicerade kontrast inställningar:
Patient med apikal hypertrofi:
THI med MI 1,2
THI med MI 1,2
THI med MI 0.3
Power modulation med MI 0.3
Bubbles to the people…