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European Journal of Echocardiography 2005 6(2):134-143; doi:10.1016/j.euje.2004.08.003
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Copyright © 2005, The European Society of Cardiology

Quantitative evaluation of regional endocardial visualisation with second harmonic imaging and contrast left ventricular opacification in heart failure patients

Gillian A. Whalley*, Greg D. Gamble, Helen J. Walsh, Norman Sharpe and Robert N. Doughty

Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand

Received 2 March 2004; received in revised form 3 August 2004; accepted after revision 3 August 2004.

* Corresponding author. Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92 019, Auckland, New Zealand. Tel.: +64 9 373 7599x89809; fax: +64 9 367 7146. g.whalley{at}auckland.ac.nz


  Abstract

Aims Wall motion score index (WMSI) is an important prognostic indicator in heart failure (HF) patients but requires endocardial visualisation. This study evaluated the role tissue harmonic imaging (THI) and contrast opacification (LVO) for improving endocardial visualisation and the determination of WMSI in HF patients.

Methods and results Thirty-one HF patients and 30 controls underwent apical echocardiography with fundamental imaging (FUND), THI and THI with contrast agent (Levovist®). Visualisation and motion were graded in the six segments from each of the apical two and four chamber views. Both THI and LVO reduced the percentage of non-visualised segments (FUND 13.6%, THI 5.6%, LVO 2.8%, p=0.01) in the controls, but in HF patients, only THI improved visualisation (% segments not visualised FUND 9.7%, THI 3.5%, LVO 4.8%, p=0.06). The anterior and lateral walls were the least well visualised with FUND, but improved with LVO (anterior p=0.0026, lateral p=0.0003). No improvement was seen in the inferior wall (p=0.30) or septum (p=0.2). WMSI was similar by all methods and negatively correlated with ejection fraction (FUND r=–0.69, THI r=–0.74, LVO r=–0.77, all p<0.001).

Conclusion THI improved endocardial visualisation in all subjects and LVO offered additional benefit in the controls, but not in HF patients. Regional endocardial visualisation was inconsistent. Thus, both patient factors and wall segment site need to be considered when using contrast agents for endocardial visualisation.

Keywords: Contrast; Harmonics; Endocardial; Visualisation; WMSI; Heart failure


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