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Bedside Myocardial Perfusion Assessment with Contrast Echocardiography

  • Chapter
Annual Update in Intensive Care and Emergency Medicine 2016

Part of the book series: Annual Update in Intensive Care and Emergency Medicine ((AUICEM))

Abstract

Myocardial perfusion can be safely assessed at the bedside using contrast echocardiography. The contrast agents consist of tiny microbubbles (approximately 1–8μm in diameter), which remain in the systemic circulation for ~ 3–5 min after venous injection. Low intensity ultrasound imaging is required to prevent the microbubbles from being destroyed. Myocardial perfusion is assessed by destroying the microbubbles with a ‘flash’ of higher intensity ultrasound and then analyzing the replenishment rate as the microbubbles seep back into the myocardial circulation.

There is reasonable evidence that myocardial contrast perfusion echocardiography (MCPE) can help in the detection of coronary artery disease as well as having prognostic value over regional wall motion analysis. However, there are challenges in bringing it into everyday clinical use: the imaging is challenging and relatively complicated compared to standard echocardiography; the sensitivity and specificity are not 100%; it remains an ‘off-label’ use of contrast echocardiography; and there are safety issues to consider. It has been investigated for more than 25 years and yet still has not made it into main-steam cardiac evaluation.

One area of considerable interest and future potential is in critically ill patients who have raised cardiac enzymes, especially troponins, with or without electrocardiogram (EKG) abnormalities or regional wall motion abnormalities, in whom the diagnosis of ischemia needs to be addressed. Examples include Takotsubo’s or septic cardiomyopathy. Investigation with angiography or further imaging may be detrimental in patients with acute renal failure or bleeding risk and there are dangers associated with unnecessary transfer. It is not suggested that MCPE would take the place of angiography or other investigations assessing myocardial perfusion, but potentially MCPE could identify patients (or at least triage them) who have normal myocardial perfusion yet abnormal troponins, EKGs and have regional wall motion abnormalities. In addition, there are exciting implications for the future use of microbubble contrast in terms of drug and gene delivery.

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Authors and Affiliations

  1. Intensive Care Unit, Nepean Hospital, 2747, Sydney, NSW, Australia

    S. Orde & A. McLean

  2. Sydney Medical School, University of Sydney, Sydney, Australia

    A. McLean

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  1. S. Orde
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  2. A. McLean
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Correspondence to S. Orde .

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Editors and Affiliations

  1. Université libre de Bruxelles Dept. of Intensive Care, Erasme Hospital, Brussels, Belgium

    Jean-Louis Vincent

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Orde, S., McLean, A. (2016). Bedside Myocardial Perfusion Assessment with Contrast Echocardiography. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2016. Annual Update in Intensive Care and Emergency Medicine. Springer, Cham. https://doi.org/10.1007/978-3-319-27349-5_14

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  • DOI: https://doi.org/10.1007/978-3-319-27349-5_14

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-27348-8

  • Online ISBN: 978-3-319-27349-5

  • eBook Packages: MedicineMedicine (R0)

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