Copyright © 2006, The European Society of Cardiology
Freehand three-dimensional assessment of left ventricular volumes and ejection fraction with ultrasound contrast agent LK565
aMedizinische Klinik III, University Hospital Tuebingen, Eberhard-Karls-University, Otfried-Mueller-Strasse 10, 72076 Tuebingen, Germany tobias.geisler{at}med.uni-tuebingen.de
bDepartment of Cardiology, Herzzentrum Leipzig, Germany chri.ro{at}web.de
cMedizinische Klinik II, University Hospital Mainz, Johannes Gutenberg-University, Langenbeckstr. 1, 55131 Mainz, Germany
dDepartment of Internal Medicine III, Klinikum Herford, Schwarzenmoorstr. 70, 32049 Herford, Germany
Received 17 May 2005; received in revised form 20 November 2005; accepted after revision 4 December 2005.
* Corresponding author. Tel.: +49 5221 94 2248; fax: +49 5221 94 2148. rainer.zotz{at}klinikum.herford.de
 |
Abstract |
|---|
Aims Accurate assessment of left ventricular function by determining left ventricular volumes and ejection fraction is important in evaluating the prognoses of patients with heart failure. Two-dimensional (2D) echocardiography suffers from low correlation with reference methods like ventriculography. Three-dimensionally (3D) assessed data have been proved to have better conformity. Endocardial border delineation remains a problem, however, especially in patients with suboptimal recordings. Few data exist on 3D-echocardiographic volumetry with ultrasound contrast agents (UCAs). We evaluated the second-generation UCA LK565 for its boundary-tracing capacities in freehand 3D echocardiography in a phase II clinical trial. Safety and efficacy of the novel contrast agent were also evaluated.
Methods and results Forty patients between the age of 42 and 77 were included in this trial. Left ventricular end-systolic and -diastolic volume (LVESV, LVEDV) and ejection fraction (EF) were determined by either 2D or 3D freehand second harmonic echocardiography with and without use of LK565. Parameters were compared statistically with ventriculography performed in 35 patients. Immune response to LK565 was evaluated by analysing phagocytosis capacity and kinetics of inflammatory cytokines (TNF-
, IL-4, IL-10, IFN-
). Patients were monitored for adverse events up to 72h after application of the UCA.
Calculated values for left ventricular volumes and ejection fraction correlated best for freehand 3D echocardiography in combination with LK565 (r=0.92 for LVEDV; r=0.96 for LVESV; r=0.94 for EF). Excellent left ventricular contrast enhancement was achieved for approximately 8min. A reversible saturation of phagocytosis capacity for monocytes and neutrophils set in with a maximum peak at 6h. No significant increase in cytokine expression was observed.
Conclusion LK565 improves feasibility of endocardial border delineation in 3D echocardiography, leading to better correlation of left ventricular volumetry with reference methods. Efficacy and safety of LK565 are equivalent to those of conventional UCAs.
Keywords: 3D echocardiography; Ultrasound contrast agent; Freehand ultrasound
e Tel.: +49 7071 2983688. tobias.geisler{at}med.uni-tuebingen.de
f Klosterstrasse 40a, 97236 Randersacker, Germany. Tel.: +49 931 708608. chri.ro{at}web.de