J Korean Soc Echocardiogr.  1994 Dec;2(2):143-154. 10.4250/jkse.1994.2.2.143.

Changes in Video Density of the Left Ventricle by Transpulmonary Administration of Sonicated Albumin: Contrast Echocardiographic Study

• Chang KS
• Kim SD
• Lee MJ
• Jeon IS
• An KW
• Hong SP
• Tei C
• Tanaka N

• KMID: 2410442
• DOI: http://doi.org/10.4250/jkse.1994.2.2.143

Abstract

With the advance of color-Doppler echocardiography, there has been many studies on the hemodynamics of the left ventricle. Doppler echocardiography, however, has many limitations, and the recently developed contrast echocardiography has overcome those limitations. The purpose of this study is to analyze of the blood flow hemodynamics of the left ventricle by transpulmonary contrast echocardiography. Subjects were fifteen healthy volunteers(group I), fifteen patients of various heart diseases(group 2), and thirteen patients with dilated cardiomyopathy(group 3). We used sonicated albumin, and a videodensitometer for the analysis of the base, midventricle and apex of the left ventricle. Among the total 43 subjects, left ventricular opacifications were obtained in 28 subjects(65.1%). Tehre were systolic decreases in group 1(68.5±1.7%), and group 2(67.0±1.4%), and the systolic decrease correlated with the mean blood pressure(r=0.46, p < 0.05), and ejection fraction(r=0.62, p < 0.01) of the subject, while it showed no correlation with the systolic blood pressure. There were three definitive diastolic filling patterns, type A : early diastolic peak and late diastolic peak, thpe B : only early diastolic peak with a slow decrease, type C : three different peak times of base, midventricle and apex of left ventricle. The difference between the peak times of the base and midventricle and between the midventricle and apex of the left ventricle of group 3(dilated cardiomyopathy) were 4.1±1.4, 4.7±1.8, different from those of group 1 and 2 significantly(p < 0.001, respectively) According to the above results, contrast echocardiography with sonicated albumin is useful for the analysis of blood flow patterns of the left ventricle.

Keyword

Contrast echocardiography; Sonicated albumin

MeSH Terms

Blood Pressure
Echocardiography*
Echocardiography, Doppler
Heart
Heart Ventricles*
Hemodynamics
Humans

Figure

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  Fig. 1. Measurement of contrast intensity during a cardiac cycle(32 frames from QRS to next QRS). Contrast intensity decreases during systole(from first frame to eleventh frame; systolic decrease), fills the left ventricle rapidly to reach the peak, and decreases. Left; region of interest(divided by three regions; base, midventricle, and apex).

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  Fig. 2. An example of contrast echocardiography. Left: Apical 4 chamber view on baseline. Middle: After injection of sonicated albumin, contrast fills in the right atrium and ventricle. Right: Contrast enters the left atrium and ventricle.

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  Fig. 3. Contrast disappearance curve of left ventricle obtained by continuous end-diastolic frame(tip of QRS). The contrast intensity is begun from near zero to 112 gray scale level, reaches peak intensity in eleventh beats and disappeared in 24th beats.

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  Fig. 4. Systolic decrease of contrast intensity. Left: In diastole, contrast fills in left ventricle. Right: In late systole, contrast intensity in left ventricle is decreased.

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  Fig. 5. Relation of between systolic blood pressure and systolic reduction of contrast intensity in left ventricular cavity.

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  Fig. 6. Relation between mean blood pressure and systolic reduction of contrast intensity in left ventricular cavity.

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  Fig. 7. Changes of contrast intensity of base(Base). midventricle(Mid). and apex(Apex) of left ventricle in type A pattern from QRS to next QRS. Note the decrease of the contrast intensity during systole(from first frame to 20th frame) and the increase during early diastole. Left side means mean intensity of base, midventricle and apex of left ventricle.

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  Fig. 8. Changes of contrast intensity of base(Base). midventricle(Mid). and apex(Apex) of left ventricle in type A pattern of the frames obtained by 50 msec, interval. Two cardiac cycles was obtained. Note the changes of contrast intensity during diastole(from tenth frame to 21st frame: early diastole, from 21st frame to 24th frame) and the systolic decrease of contrast intensity(from 25th frame to 38th frame).

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  Fig. 9. Changes of contrast intensity of base(Base), midventricle(Mid), and apex(Apex) of left ventricle in type B pattern of the frames obtained by 50 msec, interval. Two cardiac cycles was obtained. Note the changes during diastole(from 14th frame to 28th frame), a contrast intensity decreased slowly and no definitive late diastolic increase.

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  Fig. 10. Changes of contrast intensity of base(Base). midventricle(Mid). and apex(Apex) of left ventricle in type C pattern from QRS to next QRS. Note the three definite and separated peaks of base, midventricle and apex of left ventricle.

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  Fig. 11. Changes of contrast intensity of base(Base), midventricle(Mid). and apex(Apex) of left ventricle in type C pattern of the frames obtained by 50 msec, interval. Two consecutive cardiac cycles was obtained. Note the three definite and separated peaks of base, midventricle and apex of left ventricle.

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  Fig. 12. Changes of contrast intensity of base(Base). midventricle(Mid). and apex(Apex) of left ventricle of the frames obtained by 50 msec, interval in patients with atrial fibrillation. Note the changes of contrast intensity during variable cardiac cycle.

Reference

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