2012 Contrast Echocardiography Jonathan Lindner
<p>Oct 20, 2014 07:45 PM This is outstanding!!! (LIFE-CHANGING!!)
will give CVI talk On Oct 21 at noon.</p>
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This is a talk from 2012...</p>
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microbubbles contrast aents... cannot deflate on way to microvasc.
shells: albumin; lipids, put in gases... rings in the sono... abt 1/3 diam of rbc
(in his slide mm = micron = micrometer) bubble are abt 2-3 microns.
shell and special gas... move thru capillaries.</p>
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use it for LV opacification...
where do bubble help you...</p>
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imrpoves dx; improves interp segments, post-exercise studies;</p>
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huge improvement with contrast;</p>
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using this on obese pts; weent from tech difficult to easily interp. saves money by
avoiding other tests.</p>
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study kinetics of LV;</p>
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do this with exercise echo; can see hypokinessi;</p>
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results of the stress echo with contrast are... multivessel- high risk...</p>
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angio 3 vessel CAD is compared; shows occlus RCA;</p>
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can see contrast as it moves thur microcirc... see microbubbles!!!</p>
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see min 16:21 !!!!! we do this daily; helps pt of care decisions!!!
perfusion imaging; our microbubbles behave just like RBCs...
small arterioles... they don't lodge... shows graph of velocities!
can see it move thru microcirc of muscle!!! unique look at perfusion...</p>
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infuse microbubbles; sono at high power; apical 4 chamber;
destroy a slab of bubbles... destroy bubble and watch how fast they come back!!!
femoral artery... can see vaso vasorum;</p>
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how fast do they come backin and how bright does it get...</p>
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can measure volume of blood... fits to an expon function...</p>
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can get quantit and spatial idea of regional perfusion...
can quantify blood flow spatially...</p>
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Note: at <b>22:32 quality of video greatly improves</b>!!!</p>
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see an actual slide: major determinants of infarct size:</p>
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time of occlusion; O2 demand during occlusion; extent of collat;
size of perfusion terrir of IRA;= infarct related artery
can check reflow...</p>
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get good recovery of func if resid blood flow (collateral or resid antegrade flow etc. minute 26....
wall is destined to improve (if any residual flow)...</p>
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pt got outside thrombolytic rx;.
DX of CAD
daily basis to dx CAD;;; do STRESS;
vast majority of pts with CAD do not have flwo limiting stenosis;
nl flow is 1-2 ml per min per gram of tissue
must havve 85% stenosis before flow is limited at rest;
if moder
nl blood flow is 1 ml per minute per gram of tissue...</p>
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should incr flow by 3 to 5 fold with dipyrid or with dobut/ stress;</p>
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see a little rim of darkness after the flash...
flow limiting stenosis at rest!!! (restin ghypperfusion)
critical stenosis in LAD... dx in 2 mins at bedside...</p>
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remember this relationship; flow and radial wall thickening during dobutamine...
at peak dobut. dog model graded cor stensosis...</p>
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normal wall thickening is abt 30% at rest...
at mild to moder stenosis you do NOT see wall thickening... only has sensit in 70s
its NOT there... will not see moder stenosis.</p>
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minute 29....</p>
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see little rim of darkness after flash in end systolic frames only get this if critical stenosis
like > 85%...</p>
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stress echo only has sensit in the 70s... its not there!
wall thickening is not there...
must use perfusion to see it...</p>
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from Tom Porter;;
compare perfusion to wall thickening...
DSE = dobut stress ech.... he can see an RCA stensosis;
sensitivity is incr at even intermed DB (sometimes we don't get pts up to max dose DB = dobut)</p>
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no indications for this in US yet (in 2012)...we use it a lot for off label uses...</p>
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future stuff: research apps in 2012: the future stuff...
easy cheap way for looking at perfusion; using contrast ultrasound...
sonothrombolysis;</p>
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quantit assessment of perfusion;</p>
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studying ESC rx!
can make bubbles smart....
use them for dissolving thrombus!</p>
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hyperlipidemia decr flow reserve; blood becomes more viscous;
induces hyperlipidemia and shows RBCs slowing down during hyperlipidemia;</p>
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<b>hyperlipidemia causes endothel dysfunction</b>
<b>rbc's don't deform as much minute 35...</b>
<b>RBC move much more slowly during hyperlipidemia...</b>
<b>effect of hyperlipid on Rheology !!!! holy fk!!</b></p>
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nasty stiff RBCs would not move thru caps...
(<b>Throw away the butter!</b>!)</p>
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shows PNH pt; parox nocturnal hemo.
put siliris... rate of mvmt of RBCs improved...</p>
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rate of mvmt thru microcirculation!!!</p>
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* now fun future stuff</p>
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nuclear, MRI, CT... molec imaging and same for contrast echo... portable, rapid...
smart contrast agents.... info immed to clinician.</p>
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shows leukocytes rolling in a venule... upreg of selectins...
grabs leukocytes...
molec imaging... close to 1st clinical trials... see leukocytes...
look venules... selectins... adhesion molecules...
WBCs are sniffing... do we need a full blown inflam response or not...
selectins will stay upreg for 16 to 24 hours....
WBCs bind to PSGL1... smart bubbles stick to same thing
smart microbubbles... IV inject wait 5 mins....
fluor bubbles targeted to selectins...
they only get stuck if ischemic...(in post ischemia bubbles get stuck)</p>
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"I had chest pain 2 or 5 hours ago... was it ischemia or was it bad dumplings..."
at bedside was CP due to ischemia or not... works all the way out to 16 to 18 hours.</p>
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did mouse model... did tempor cor occlusion and then can detect it later...</p>
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detect CAD at v early stage! I think its a <b>curable disease if you can find it early enuf</b>...
mice study: 10, 20 40 weeks: at 40 weeks of age: big plaques...
almost none at 10 weeks - early just see monocytes entering vessel wall; earliest start;
give smart bubbles... stick to same areas where monocytes are sticking...</p>
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the voice of crystal bubble, charms us at once away from all our troubles;</p>
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if not using contrast sono... you are doing a <b>disservice</b> to your pts...
eg Bill Zogby lab... Jon is vice chair of Natl board of echo...
he runs a meeting... Echo Hawaii every January... we do discuss contrast.
fair amt of contrast in the echo boards! (so learn it)</p>
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lecture ends around min 50 or so then demo by his tech (can skip);</p>
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