Sabati Arash, Wang Shuo, Shivaram Pushpa, Hawley Joshua, Thompson David, Erenberg Francine, Kutty Shelby, Kulkarni Aparna, Doan Tam T, Robinson Joshua D
Division of Cardiology, Center for Heart Care, Phoenix Children's Hospital, 1919 E Thomas Road, Phoenix, AZ, 85016, USA.
Children's Hospital Los Angeles, Los Angeles, CA, USA.
Pediatr Cardiol. 2025 Aug 27. doi: 10.1007/s00246-025-03993-4.
Contrast-enhanced echocardiography (CE-echo) is commonly used in adult patients to optimize endocardial border delineation (EBD) but there is limited experience in children. A prospective, open-label, non-randomized, multicenter study was performed to evaluate the efficacy of intravenous Optison for CE-echo in pediatric patients and determine the optimal dose of Optison. Subjects ≥ 9 and < 18 years with suboptimal echocardiograms (defined as ≥ 2 contiguous segments that could not be adequately visualized) were enrolled. After a baseline non-contrast echocardiogram (NC-echo), CE-echo was performed with 2 dose levels of Optison based on patient weight. The primary endpoint was visualization of the LV wall segments (LVWS) in apical 2- and 4-chamber views. An EBD score was calculated by assigning a value from 0 (no visualization) to 3 (optimal visualization) for 12 LVWS. 37 subjects across 8 sites completed the study. 30 had complete echocardiograms at both dose levels. 2 patients had usable images at dose 2 only. Mean age was 13.4 years (± 2.6) with 23 males (62%). Mean weight was 73.9 kg (± 36.8) with wide distribution of weight (interquartile range of 42-102 kg). There were 8 patients under 40 kg. Most subjects had a prior medical/surgical history (n = 33, 89%). Both dose levels of Optison CE-echo improved the number of LVWS visualized from 3.7 ± 1.1 on NC-echo to 10.0 ± 0.1 with dose 1 (p < 0.001) and 10.5 ± 0.1 with dose 2 (p < 0.001). EBD score also improved at both dose levels from 11.9 ± 2.5 for NC-echo to 28.5 ± 1.7 for dose 1 (p < 0.001) and 30.2 ± 8.4 for dose 2 (p < 0.001). The number of suboptimal echocardiograms improved from 92.3% ± 10.7 in NC-echo to 26.2% ± 9 with dose 1 (p < 0.001) and 30.8% ± 4.5 with dose 2 (p < 0.001). CE-echo with intravenous Optison in pediatric patients improved the number of LVWS visualized, improved EBD score, and reduced the number of suboptimal echocardiograms at both dosages used in this study. Intravenous Optison can improve LV visualization in pediatric patients with suboptimal echocardiograms.
对比增强超声心动图（CE-echo）常用于成年患者以优化心内膜边界描绘（EBD），但在儿童中的经验有限。一项前瞻性、开放标签、非随机、多中心研究旨在评估静脉注射Optison用于儿科患者CE-echo的疗效，并确定Optison的最佳剂量。纳入年龄≥9岁且＜18岁、超声心动图检查结果欠佳（定义为≥2个连续节段无法充分显影）的受试者。在进行基线非对比超声心动图（NC-echo）后，根据患者体重使用2个剂量水平的Optison进行CE-echo检查。主要终点是在心尖两腔和四腔视图中左心室壁节段（LVWS）的显影情况。通过为12个LVWS分配从0（未显影）到3（最佳显影）的值来计算EBD评分。8个中心的37名受试者完成了研究。30名受试者在两个剂量水平下均获得了完整的超声心动图。2名患者仅在剂量2时有可用图像。平均年龄为13.4岁（±2.6），男性23名（62%）。平均体重为73.9 kg（±36.8），体重分布范围广（四分位间距为从42至102 kg）。有8名患者体重低于40 kg。大多数受试者有既往内科/外科病史（n = 33，89%）。两个剂量水平的Optison CE-echo均使LVWS显影数量从NC-echo时的3.7±1.1增加到剂量1时的10.0±0.1（p＜0.001）和剂量2时的10.5±0.1（p＜0.001）。两个剂量水平的EBD评分也均有所改善，从NC-echo时的11.9±2.5提高到剂量1时的28.5±1.7（p＜0.001）和剂量2时的30.2±8.4（p＜0.00）。超声心动图检查结果欠佳的比例从NC-echo时的92.3%±10.7降至剂量1时的26.2%±9（p＜0.001）和剂量2时的30.8%±4.5（p＜0.001）。本研究中使用的两个剂量的静脉注射Optison进行CE-echo均增加了LVWS显影数量，改善了EBD评分，并减少了超声心动图检查结果欠佳的比例。静脉注射Optison可改善超声心动图检查结果欠佳的儿科患者的左心室显影情况。
