Fukui O, Lim Y J, Nakatani D, Kawano S, Kodama K, Masuyama T, Asanuma H, Hori M, Mishima M
Department of Cardiology, Kawachi General Hospital, Osaka.
J Cardiol. 1998 Feb;31(2):99-107.
Contrast enhancement of the left heart cavity and myocardium were assessed after venous injection of the ultrasound contrast agent Albunex. Myocardial perfusion was also assessed using a drug stress and image analyzing system. The study population consisted of 46 patients with normal cardiac function and without coronary artery disease, and 38 patients with effort angina. Contrast echocardiography was performed by imaging the parasternal or apical long-axis view during pulmonary arterial injection of Albunex through a Swan-Ganz catheter. Contrast enhancement in the left ventricular cavity and ascending aorta were visually assessed. Hemodynamic, arterial blood gas and electrocardiography changes were recorded before and after the injection of Albunex. Contrast echocardiography was performed before and during intravenous infusion of dipyridamole to assess left ventricular myocardial enhancement by both visual inspection and peak background-subtracted gray level using an image analyzing system. Doppler flow signal change after the injection of Albunex was assessed in 26 patients using a Doppler guide wire located in the left anterior descending coronary artery. Good contrast enhancement was obtained in all patients in the left ventricular cavity and in 17% of patients in the ascending aorta. No significant changes were observed in hemodynamics, electrocardiograms and aortic gas analysis. Significant myocardial enhancement was not seen in any patient but gray level analysis of the echo images during dipyridamole infusion showed significant enhancement in 25% of the patients without coronary artery disease and in 34% of the patients with effort angina. Doppler flow signal in the coronary artery was significantly augmented in all patients after injection of Albunex and suggests that ultrasound contrast agent reaches coronary arteries in all patients regardless of myocardial contrast enhancement. Contrast echocardiography with pulmonary arterial injection of Albunex is safe and useful to obtain sufficient left ventricular contrast enhancement. For myocardial perfusion assessment, further refinement of the ultrasound contrast agent and echo equipment is necessary.
静脉注射超声造影剂Albunex后，评估左心腔和心肌的对比增强情况。还使用药物负荷和图像分析系统评估心肌灌注。研究人群包括46例心功能正常且无冠状动脉疾病的患者以及38例劳力性心绞痛患者。通过经Swan-Ganz导管在肺动脉注射Albunex期间，对胸骨旁或心尖长轴视图进行成像，来进行对比超声心动图检查。对左心室腔和升主动脉的对比增强进行视觉评估。在注射Albunex前后记录血流动力学、动脉血气和心电图变化。在静脉输注双嘧达莫之前和期间进行对比超声心动图检查，通过视觉检查和使用图像分析系统减去背景峰值灰度水平来评估左心室心肌增强情况。在26例患者中，使用位于左前降支冠状动脉的多普勒导丝评估注射Albunex后的多普勒血流信号变化。所有患者的左心室腔均获得了良好的对比增强，17%的患者升主动脉也有良好的对比增强。血流动力学、心电图和主动脉气体分析均未观察到显著变化。在任何患者中均未观察到显著的心肌增强，但在双嘧达莫输注期间对回声图像进行灰度分析显示，25%无冠状动脉疾病的患者和34%劳力性心绞痛患者有显著增强。注射Albunex后，所有患者冠状动脉中的多普勒血流信号均显著增强，这表明无论心肌对比增强情况如何，超声造影剂均可到达所有患者的冠状动脉。经肺动脉注射Albunex的对比超声心动图对于获得足够的左心室对比增强是安全且有用的。对于心肌灌注评估，有必要进一步改进超声造影剂和超声设备。
