Background and Objective: The diagnosis of left ventricular pseudoaneurysm after acute myocardial infarction is usually based on echocardiography. However, this technique may have limitations in some patients, especially in cases with suboptimal acoustic window. The objective of this study was to evaluate the usefulness of contrast echocardiography in the diagnosis of left ventricular pseudoaneurysm after myocardial infarction.

Methods and Results: The study population comprises six patients in whom a two-dimensional echocardiography showed an image consistent with left ventricular pseudoaneurysm. Levovist® (Schering) 4 gr was administered i.v. to more clearly visualize the blood flow from the left ventricle to the left ventricular pseudoaneurysm cavity in all patients. Infarct location was anterior in five patients, and posterolateral in one. No patient had received thrombolysis or primary angioplasty during the acute phase. The transthoracic echocardiographic study showed an echo-free space adjacent to left ventricle in all patients. In four cases, the diagnosis of left ventricular pseudoaneurysm was made before contrast administration. In the remaining two patients, the definite diagnosis was made only after Levovist® administration.

Conclusion: In the diagnosis of postinfarction left ventricular pseudoaneurysm, the administration of contrast agents may be of help in the correct visualization of the blood flow from the left ventricle to the left ventricular pseudoaneurysm cavity, and may allow a definite diagnosis to be obtained in some patients. Copyright 2002 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved .

Usefulness of contrast agents in the diagnosis of left ventricular pseudoaneurysm after acute myocardial infarction.

Aim: Interobserver variability is an important limitation of the stress echocardiography and depends on the echocardiographer training. Our aim was to evaluate if the use of contrast agents during dipyridamole stress echocardiography would improve the agreement between an experienced and a non-experienced observer in stress echo and therefore if contrast would affect the learning period of dypyridamole stress echo. Methods and results: Two independent observers without knowledge of any patient data interpreted all stress studies. One observer was an experienced one and the other had experience in echocardiography but not in stress echo. Two observers analysed 87 non-selected and consecutive studies. Out of the 87 studies, 46 were performed without contrast administration, whereas i.v. contrast (2.5 g Levovist® by two bolus at rest and at peak stress) was administered in 41. In all cases, second harmonic imaging and stress digitalisation pack was used. The agreement between observers showed a κ index of 0.58 and 0.83 without and with contrast administration, respectively. Conclusions: The use of contrast agents provides a better agreement in the evaluation of stress echo between an experienced and a non-experienced observer in stress echo. Adding routinely contrast agents could probably reduce the number of exams required for the necessary learning curve in stress echocardiography.

Contrast agents provide a faster learning curve in dipyridamole stress echocardiography.

https://www.internationaljournalofcardiology.com/article/S0167-5273(03)00037-8/pdf

Evaluation of myocardial perfusion with grey-scale ultra-harmonic and multiple-frame triggering. The need for quantification

Ecocardiografía Doppler en la cardiopatía isquémica

Introduccion La ecocardiografia de estres farmacologico es una tecnica fiable en el estudio de la enfermedad coronaria. Sin embargo, una de sus principales limitaciones es la variabilidad interobservador, relacionada con diversos factores que incluyen la calidad de la imagen, asi como la experiencia del examinador. Objetivos Valorar si el empleo de ecopotenciadores durante la ecocardiografia con dobutamina mejoraria la variabilidad entre dos observadores, un observador experto en ecocardiografia de estres y un segundo observador sin experiencia en la tecnica, y si influiria sobre la curva de aprendizaje. Metodos Los ecocardiogramas de estres fueron interpretados por dos observadores independientes: el primero (A) con experiencia en ecocardiografia de estres y el segundo (B) sin experiencia en la tecnica. Todos los estudios se realizaron con segundo armonico y digitalizacion de las imagenes. El agente de contraste empleado fue Levograf/Levovist® 2,5 g en dos bolos, en reposo y en el maximo estres. El grado de acuerdo interobservador fue evaluado mediante el coeficiente kappa. Resultados Se han analizado 52 estudios realizados en 51 pacientes no seleccionados y consecutivos. Se utilizo contraste en 22 estudios. En la ecocardiografia con dobutamina sin contraste, el grado de acuerdo se estimo con un coeficiente kappa de 0,52, mejorando solo ligeramente el acuerdo entre los dos observadores al emplear contraste (kappa = 0,58; sin diferencias significativas entre las kappa). Conclusiones El empleo rutinario de contraste mejora ligeramente, sin alcanzar diferencias significativas, el grado de acuerdo en la interpretacion de la ecocardiografia de estres. Sin embargo, esta mejoria no sustituye el periodo de formacion necesario en la tecnica.

Vivi Serra

Papers

Influencia de la administración de ecopotenciadores sobre la variabilidad interobservador en la ecocardiografía de estrés con dobutamina