ECHO 2013 / Contrast for Diagnosis and Therapy

Contrast for Diagnosis and Therapy

James D. Thomas, M.D., F.A.C.C.

Cardiovascular Imaging Center

Department of Cardiology

The Cleveland Clinic Foundation

Cleveland, Ohio, USA

Past-President, American Society of Echocardiography

Conflict of Interest: None

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80 yo Man with Exertional Dyspnea s/p CABG, PCI, now severe DOE

Severe LV dysfunction

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What’s going on in the apex??

A.Thrombus

B.Reverb/nearfield artifact

C.Can’t tell, let’s try contrast

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• Severe apical dysfunction but no sign of clot

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Transpulmonary Ultrasound

Contrast Agents?

Tiny microbubbles (2-5µm) sized to pass through capillaries

Use gas with low diffusivity

Increase echo signal strength

Shell: 15 - 25 nm Albumin

Lipid

Surfactant

Galactose

Polymer

2 - 5

Air

Nitrogen

Gas PFC

SF6

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Examples of Commercially-Produced

Microbubble Contrast Agents

*Approved for use by the US FDA for LV opacification

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Safety Concerns

The “Black Box” Warning

October 10, 2007

Warning: serous cardiopulmonary reactions and

fatalities within 30 min of contrast administration

Contraindications: any ACS, unstable CHF, ventricular arrhythmias

Administration guidelines: 30 min observation period with vital signs, ECG and O2 monitoring

May 14, 2008

Warning: serous cardiopulmonary reactions and fatalities within 30 min of contrast administration

Administration guidelines: 30 min observation in patients with PH or unstable cardiopulmonary cond.

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Salvaging nondiagnostic echoes

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