Stress-induced ST-segment elevation after a recent myocardial infarction: myocardial necrosis, viability or both?
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Adrenergic beta-Antagonists↗
Biomedical subjects
A Elhendy
Publications and source records attributed to A Elhendy.
Accuracy of dobutamine stress echocardiography for the diagnosis of coronary artery stenosis in patients with myocardial infarction: the impact of extent and severity of left ventricular dysfunction.
OBJECTIVES: To assess the value of dobutamine stress echocardiography (DSE) in the prediction of the extent and location of coronary artery stenosis in symptomatic patients with old myocardial infarction and to study the impact of the severity of resting wall motion abnormalities (WMA) on the diagnostic accuracy of the test. PATIENTS: One hundred and thirty two symptomatic patients with old myocardial infarction. METHODS: DSE (up to 40 micrograms/kg/min, with atropine up to 1 mg) was performed in all patients. Ischaemia was defined as new or worsened WMA. For each coronary artery, regional wall motion in the corresponding territory was classified as normal, mildly, moderately, or severely impaired according to the wall motion score index. Significant coronary stenosis was defined as > or = 50% diameter stenosis. RESULTS: A positive DSE for ischaemia occurred in 87 of 111 patients with and three of 21 patients without coronary artery stenosis (sensitivity = 78%; CI 71 to 86, specificity = 86%; CI 79 to 92, accuracy = 80%; CI 73 to 87). The accuracy for the diagnosis of individual coronary stenosis was 69% in the presence of normal wall motion and 74%, 74%, and 61% respectively when there was mild, moderate, and severe WMA in the corresponding territories (P = NS). The sensitivity was higher in presence of mild or moderate WMA (73%) than with normal wall motion (53%) or severe WMA (56%, P < 0.05 in both). In territories subtended by a stenotic artery, the regional wall motion score index was not different with or without ischaemia. CONCLUSION: DSE had a good overall accuracy for the diagnosis of coronary artery stenosis in symptomatic patients with old myocardial infarction. The presence of resting WMA did not limit DSE as a method of eliciting myocardial ischaemia and diagnosing significant coronary artery stenosis in patients with old myocardial infarctions.
Aged↗
Akinesis becoming dyskinesis during dobutamine stress echocardiography. A predictor of poor functional recovery after surgical revascularization.
BACKGROUND: Akinesis becoming dyskinesis at high-dose dobutamine stress echocardiography (DSE) has been disregarded as a marker of myocardial ischemia. However, to our knowledge, the relationship between this pattern and myocardial viability has not been assessed. METHODS: We studied 42 patients with myocardial infarction who underwent DSE (up to 40 micrograms/kg/min) before coronary artery bypass surgery, and resting echocardiogram 3 months after surgery. Viability in akinetic segments was considered to be present if systolic thickening occurred with low-dose dobutamine (LDD). RESULTS: During high-dose DSE, dyskinesis occurred in 35 of the 164 akinetic segments (group A). The remaining 129 segments comprised group B. Segments of group B had a higher prevalence of viability pattern with LDD (18% vs 0%; p < 0.01) and a higher prevalence of functional improvement (20% vs 0%; p < 0.005) compared with group A. In absence of viability pattern with LDD, postoperative improvement occurred in 10% of segments in group B and in none of segments in group A, resulting in a higher negative predictive value of LDD in group A vs B (100% vs 90%; p < 0.05). CONCLUSION: The phenomenon of akinesis becoming dyskinesis with high-dose DSE is associated with absence of viability pattern with LDD and poor functional outcome after surgical revascularization. Observation of this pattern provides additional data to those obtained only with LDD echocardiography.
Coronary Angiography↗
Functional assessment of ALCAPA syndrome by dobutamine stress thallium-201 SPECT and echocardiography.
Exercise 201TI SPECT has been used as a useful method for the assessment of patients with anomalous left coronary artery communicating to the pulmonary artery (ALCAPA syndrome). In this study, we described an adult patient with this anomaly who was evaluated by dobutamine stress testing in conjunction with simultaneous 201Tl SPECT and echocardiography before and after surgery. A large perfusion defect in the anterior wall, septum and apex was detected on the preoperative stress scan with partial reversibility on reinjection scan. Worsening of wall motion abnormalities in the septum and anterior wall was detected by stress echocardiography. In the studies performed 3 mo and 1 yr after reimplantation of the left coronary artery in the aorta, a smaller fixed perfusion defect in the anterior wall and apex was detected without reversibility. No stress-induced wall motion abnormalities were detected. Despite the improvement of perfusion, there was no improvement of regional or global left ventricular function at rest. We report that both dobutamine 201Tl SPECT and echocardiography were useful for the detection of reversible ischemia and for the assessment of the surgical outcome of an adult patient with ALCAPA syndrome.
Adult↗
Dobutamine thallium-201 SPECT imaging for assessment of peri-infarction and remote myocardial ischemia.
UNLABELLED: This study assessed the value of dobutamine 201Tl scintigraphy for detecting significant disease of infarct-related and remote coronary arteries in myocardial infarction patients. METHODS: Dobutamine (up to 40 micrograms/kg/min)/atropine (up to 1 mg) stress test in conjunction with stress-reinjection 200Tl SPECT was performed in 71 symptomatic patients with left ventricular dysfunction > 3 mo after myocardial infarction. Ischemia was defined as reversible perfusion defects. RESULTS: Significant coronary artery stenosis (> or = 50% luminal diameter stenosis) was detected in all patients. Sensitivity, specificity and accuracy of regional ischemia for the diagnosis of remote coronary artery stenosis were 74% (95% Cl 63-86), 80% (Cl 70-90) and 76% (Cl 65-87), respectively. Those for infarct-related artery stenosis were 71% (Cl 60-81), 83% (Cl 75-92) and 72% (Cl 61-82), respectively. Ischemic perfusion score was higher in patients with multiversus single-vessel disease (1056 +/- 1021 versus 423 +/- 633, p < 0.01). CONCLUSION: Dobutamine thallium scintigraphy is valuable for assessing the extent of coronary stenosis on the basis of reversible hypoperfusion in symptomatic patients late after myocardial infarction.
Atropine↗
Evaluation by quantitative 99m-technetium MIBI SPECT and echocardiography of myocardial perfusion and wall motion abnormalities in patients with dobutamine-induced ST-segment elevation.
ST-segment elevation during exercise testing has been attributed to myocardial ischemia and wall motion abnormalities (WMA). However, the functional significance of ST-segment elevation during dobutamine stress testing (DST) has not been evaluated in patients referred for diagnostic evaluation of myocardial ischemia. DST (up to 40 micrograms/kg/min) with simultaneous echocardiography and technetium-99m sestamibi single-photon emission computed tomography (SPECT) was performed in 229 consecutive patients with suspected myocardial ischemia who were unable to perform an adequate exercise test; 127 (55%) had a previous acute myocardial infarction (AMI). ST elevation was defined as > or = 1 mm new or additional J point elevations with a horizontal or upsloping ST segment lasting 80 ms. Reversible perfusion defects on SPECT and new or worsening WMA during stress on echocardiography were considered diagnostic of ischemia. ST elevation occurred in 40 patients (17%) during the test; 34 of them (85%) had previous AMI. All patients with ST-segment elevation had abnormal scintigrams (fixed or reversible defects, or both) and abnormal wall motion (fixed or transient defect, or both) at peak stress. In patients who had ST elevation and no previous AMI (n = 6), ischemia was detected in all by echocardiography and in 5 (83%) by SPECT. In patients with previous AMI, the prevalence of ischemia was not different with or without ST elevation (53% vs 43% by echocardiography and 53% vs 48% by SPECT, respectively). Baseline regional wall motion score in the infarct zone was higher in patients with ST elevation.(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
Stress-induced left ventricular dysfunction in silent and symptomatic myocardial ischemia during dobutamine stress test.
The extent and severity of dobutamine-induced left ventricular (LV) dysfunction with and without angina were evaluated in 105 consecutive patients with significant coronary artery disease and a positive dobutamine stress echocardiographic test, defined as new or worsening wall motion abnormalities during high-dose dobutamine stress (up to 40 micrograms/kg/min). Wall motion score (WMS) was derived using a 16-segment, 4-grade scoring method. The difference between stress and rest WMS (delta WMS) was derived as a global measure of stress-induced LV dysfunction. Typical angina occurred in 61 patients (58%) during the test. There was no significant difference between patients with or without angina with respect to age, gender, prevalence of previous myocardial infarction, multivessel disease, or number of diseased coronary arteries. Patients with angina had a higher prevalence of a history of angina before the test. Rest, stress, and delta WMS, number and distribution of ischemic segments, and number of segments with an increase in regional WMS of > or = 2 were not significantly different in patients with or without angina. ST-segment depression was more frequent in patients with angina (56% vs 29%, p < 0.05). Patients with (vs those without) ST-segment depression had a significantly higher number of ischemic segments with normal baseline contraction, an equal total number of ischemic segments, and a similar delta WMS. It is concluded that in patients with anatomically and functionally significant coronary artery disease, the amount of stress-induced LV dysfunction evaluated by dobutamine stress echocardiography is similar in patients with or without angina.(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
Prediction of improvement of regional left ventricular function after surgical revascularization. A comparison of low-dose dobutamine echocardiography with 201Tl single-photon emission computed tomography.
BACKGROUND: Although both 201Tl scintigraphy and low-dose dobutamine echocardiography (LDDE) have been proposed as effective methods of assessing myocardial viability, their relative efficacies are unknown. The aim of the present study was to compare the two imaging techniques in the prediction of improvement of regional left ventricular (LV) function after surgical revascularization. METHODS AND RESULTS: Thirty-eight patients with severe chronic LV dysfunction (ejection fraction < or = 40%, one or more akinetic [Ak] or severely hypokinetic [SH] segments on resting echocardiogram) who underwent uncomplicated coronary artery bypass graft surgery were studied with simultaneous dobutamine stress echocardiography and poststress reinjection 201Tl single-photon emission computed tomography (SPECT) before surgery. The Ak or SH segments were considered viable by LDDE when wall thickening improved during the infusion of 10 micrograms.kg-1 min 1 dobutamine. Scintigraphic definition of viability was the presence of normal 201Tl uptake, totally reversible defect, partially reversible defect, or moderately severe fixed defect. The postoperative improvement of dyssynergic segments was determined with a rest echocardiogram 3 months after surgery. Of 608 LV segments, 169 were classified as Ak and 51 as SH on resting preoperative echocardiography. Of these, 170 were successfully revascularized. Wall motion during LDDE improved in 33 severely dyssynergic segments and was more frequent in SH than in Ak segments (19 of 44 versus 14 of 126, P < .0001). Viability was detected by 201Tl SPECT criteria in 103 SH or Ak segments. Thirty-two of the 33 segments from LDDE responders were judged viable on 201Tl SPECT, whereas 201Tl viability was also detected in 71 of 137 segments from LDDE nonresponders. The sensitivity and the specificity for the prediction of postoperative improvement of segmental wall motion were 74% (95% confidence interval [CI], 67% to 81%) and 95% (95% CI, 92% to 98%) by LDDE and 89% (95% CI, 84% to 94%) and 48% (95% 40% to 56%) by 201Tl SPECT, respectively. Positive predictive value of LDDE was higher than that of 201Tl SPECT (85%, [95% CI, 80% to 90%] versus 33% [95% CI, 26% to 40%]). Thirty-six patients had angina before and only 1 had angina 3 months after revascularization. High-dose dobutamine echocardiography demonstrated significant reduction in stress-induced ischemia (new or worsening of preexisting wall motion abnormalities) after surgery (from 163 to 23 LV segments). CONCLUSIONS: In patients with severe chronic LV dysfunction, LDDE is a good predictor of the improvement of dyssynergic segments after revascularization. Because 201Tl SPECT overestimates the probability of postoperative improvement of dyssynergic segments, LDDE should be the preferred imaging technique for preoperative assessment of these patients.
Coronary Artery Bypass↗
T-wave normalization during dobutamine echocardiography for diagnosis of viable myocardium.
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Dobutamine↗
Correlation of coronary stenosis by quantitative coronary arteriography with exercise echocardiography.
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Adult↗
Prediction of improvement of ventricular function after first acute myocardial infarction using low-dose dobutamine stress echocardiography.
This study was performed to assess the prevalence of spontaneous improvement of regional left ventricular function in patients after acute myocardial infarction, and to evaluate the role of low-dose dobutamine stress echocardiography for its prediction. In 57 patients with a first acute myocardial infarction (thrombolysis, n = 27; Q-wave, n = 49), regional wall motion was evaluated with 2-dimensional echocardiography at rest, during a low-dose dobutamine stress test performed within 1 week after hospital admission, and at 3-month follow-up. Myocardial viability was considered if there was an improvement of > or = 1 grade in dyssynergic segments from rest to low-dose dobutamine infusion; recovery of regional function was defined as an improvement of > or = 1 grade between rest and follow-up echocardiograms. Wall motion score index decreased from rest to low-dose dobutamine echocardiography (1.46 +/- 0.29 to 1.39 +/- 0.30, p < 0.0001), and this change persisted at follow-up study (1.37 +/- 0.30). No differences were found between patients who did and did not undergo thrombolyis, or between those who had Q-wave and non-Q-wave infarction. At baseline echocardiography, 189 of 627 segments were dyssynergic (85 hypokinetic, 104 akinetic). Viability at low-dose dobutamine stress echocardiography was more frequent in hypokinetic than in akinetic segments (30 of 85 vs 12 of 104, odds ratio 4.18, 95% confidence interval [CI] 1.87 to 9.48).(ABSTRACT TRUNCATED AT 250 WORDS)
Dobutamine↗
Safety and feasibility of dobutamine-atropine stress echocardiography in patients with ischemic left ventricular dysfunction.
The aim of this study was to analyze whether left ventricular dysfunction affects the safety and feasibility of high-dose dobutamine-atropine stress echocardiography. We examined the results of the test in 318 consecutive patients who were referred for high-dose dobutamine-atropine stress echocardiography and also underwent diagnostic cardiac catheterization. Forty-four patients had a left ventricular ejection fraction of 25% or less (mean, 21%; range, 15% to 25%). In the entire group of 318 patients, no serious complications (death, myocardial infarction, or ventricular fibrillation) occurred. The overall feasibility of completing the test was excellent (97%). A trial fibrillation occurred in four patients, nonsustained ventricular tachycardia in 12, and sustained ventricular tachycardia in one. A decrease in systolic blood pressure of greater than 40 mm Hg or a peak systolic pressure of less than 80 mm Hg was present in eight cases. In the group with an ejection fraction of 25% or less, there was a higher rate of significant tachyarrhythmias (14% versus 5%; p = 0.03), whereas the feasibility of the test was slightly lower (89%; p < 0.01), but no difference for hypotension was found. By multivariate analysis, a history of tachyarrhythmias was the only predictor of stress-induced arrhythmias. Advanced left ventricular dysfunction does not represent a contraindication for dobutamine-atropine stress testing.
Adrenergic beta-Agonists↗
Dobutamine-atropine stress myocardial perfusion SPECT imaging in the diagnosis of graft stenosis after coronary artery bypass grafting.
OBJECTIVE: To assess the accuracy of dobutamine stress myocardial perfusion single photon emission computed tomographic imaging (SPECT) for the diagnosis of vascular stenosis after coronary artery bypass grafting (CABG). BACKGROUND: Exercise thallium scintigraphy is a clinically useful method for the diagnosis of graft stenosis after CABG. Although dobutamine perfusion scintigraphy is an alternative method for the evaluation of patients with limited exercise capacity, its value in the diagnosis of vascular stenosis after CABG has not been studied. METHODS: Dobutamine (up to 40 lg/kg/min)-atropine (up to 1 mg) stress test in conjunction with myocardial perfusion SPECT imaging (201T1 or 99m technetium sestamibi [MIBII) was performed in 71 patients (mean age 58 9 years, 57 men) with limited exercise capacity referred for evaluation of myocardial ischemia 3.7 3.5 years after CABG. Significant vascular stenosis was defined as >50% luminal diameter stenosis of a graft or a native nongrafted coronary artery and was predicted on the basis of reversible perfusion abnormalities. RESULTS: Significant vascular stenosis was detected in 52 patients. Sensitivity, specificity, and accuracy of reversible perfusion defects at dobutamine SPECT for the overall diagnosis of vascular stenosis were 81%, confidence interval (CI) 72 to 90, 79%, CI 69 to 88, and 80%, CI 71 to 90, respectively. Significant vascular stenosis was detected in 73 arterial regions. Sensitivity, specificity, and accuracy of dobutamine SPECT for the diagnosis of regional vascular stenosis were 66%, CI 58 to 74, 83%, CI 76 to 89, and 74%, CI 67 to 81, respectively. Patients with multivessel stenosis had a higher number of ischemic segments (1.6 + 1.3 vs 1 + 1, P < .05) and ischemic perfusion score (3.2 2.7 vs 2.2 + 2.3, P < .05) than patients with single-vessel stenosis, respectively. Significant graft stenosis was detected in 67 graft regions. Sensitivity, specificity, and accuracy of dobutamine SPECT for the diagnosis of regional graft stenosis were 64%, CI 56 to 73, 85%, CI 78 to 91, and 74%, CI 66 to 82, respectively. CONCLUSION: Dobutamine stress myocardial perfusion SPECT imaging is a useful method for the diagnosis of significant vascular stenosis after CABG in patients with limited exercise capacity.
Adult↗
Agreement and disagreement between "metabolic viability" and "contractile reserve" in akinetic myocardium.
BACKGROUND: In patients with chronic coronary artery disease and depressed left ventricular function, assessment of residual viability in akinetic myocardium is important for therapeutic management. Intact perfusion, preserved metabolism, and presence of contractile reserve are different aspects of cellular viability. However, not all viable cells exhibit all characteristics; it is thought that contractile reserve is less often preserved compared with metabolic activity or intact perfusion. In this study we performed a direct comparison between perfusion imaging with thallium-201 single photon emission computed tomography (SPECT), metabolic imaging with F18-fluorodeoxyglucose SPECT, and assessment of contractile reserve with low-dose dobutamine echocardiography in akinetic myocardium. METHODS AND RESULTS: Forty patients with depressed left ventricular function (mean left ventricular ejection fraction 31% +/- 16%) were studied. Resting echocardiography showed akinesis in 165 (32%) segments. Most (n = 154, 93%) of these segments demonstrated resting hypoperfusion. F18-fluorodeoxyglucose imaging revealed a perfusion-metabolism mismatch in 41 segments and a match in 113 segments. Contractile reserve was present in 33 (80%) of the segments with a perfusion-metabolism mismatch and in 7 (6%) segments with a match (P < .0005). Of the 11 segments with normal perfusion, only 5 (45%) showed contractile reserve. The agreement between SPECT and dobutamine echocardiography was 87%. Although 94% of the segments that were nonviable on scintigraphy did not show contractile reserve, the disagreement between SPECT and dobutamine echocardiography was caused mainly by the absence of contractile reserve in 27% of the segments that were viable on scintigraphy. CONCLUSION: This study shows a good agreement between SPECT and dobutamine echocardiography, although a substantial number of segments with preserved viability on SPECT do not exhibit contractile reserve, indicating underestimation of viability by dobutamine echocardiography compared with F18-fluorodeoxyglucose imaging.
Coronary Disease↗
Delayed recovery of hibernating myocardium after surgical revascularization: implications for discrepancy between metabolic imaging and dobutamine echocardiography for assessment of myocardial viability.
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Cardiotonic Agents↗
Accuracy of exercise stress technetium 99m sestamibi SPECT imaging in the evaluation of the extent and location of coronary artery disease in patients with an earlier myocardial infarction.
BACKGROUND: This study assessed the accuracy of exercise methoxy isobutyl isonitrile (MIBI) single photon emission computed tomography (SPECT) in the evaluation of the extent of coronary artery disease (CAD) in patients with an earlier myocardial infarction. METHODS AND RESULTS: We studied 135 patients (mean age, 57+/-10 years; 115 men) at a mean of 4.1 years (median, 1 year) after myocardial infarction with symptom-limited bicycle exercise stress and rest MIBI SPECT imaging. Coronary angiography was performed within 3 months. Significant CAD was defined as a stenosis of 50% or larger in luminal diameter in 1 or more major coronary arteries. Myocardial perfusion defects (fixed, reversible, or both) were detected in 107 of the 113 patients with significant CAD and in 10 of the 22 patients without significant CAD (sensitivity, 95%; CI, 91 to 99; specificity, 55%; CI, 46 to 63, and accuracy, 88%; CI, 82 to 94). The specificity rate increased to 73% (CI, 65 to 80) by using only reversible perfusion defects as a means of predicting CAD. Reversible perfusion abnormalities were more frequent in patients with multivessel CAD than in patients with single-vessel CAD (51 of 64 [80%] vs. 27 of 49 [55%], P<.01). Myocardial perfusion abnormalities in 2 vascular regions, which is suggestive of multivessel CAD, were detected in 35 of the 64 patients with and in 9 of the 71 patients without multivessel CAD (sensitivity for detecting CAD in more than one vascular region, 55%; CI, 46 to 63, specificity, 87%; CI, 81 to 93, and accuracy, 72%; CI, 64 to 80). The sensitivity rates for the diagnosis of left anterior descending coronary artery, left circumflex, and right coronary artery based on any defect were 80%, 70%, and 63%, respectively. The corresponding specificity rates were 70%, 76%, and 73%, respectively. CONCLUSIONS: Exercise MIBI SPECT imaging is an accurate method for the diagnosis and localization of CAD in patients with an earlier myocardial infarction. The technique provides a high specificity and moderate sensitivity for the diagnosis of multivessel CAD on the basis of myocardial perfusion abnormalities in more than 1 vascular region.
Adult↗
Dobutamine technetium-99m tetrofosmin SPECT imaging for the diagnosis of coronary artery disease in patients with limited exercise capacity.
BACKGROUND: Technetium-99m tetrofosmin single photon emission computed tomography (SPECT) imaging is increasingly used in conjunction with exercise and vasodilator stress test as a means of evaluating coronary artery disease (CAD). Dobutamine stress test is an alternative in patients with limited exercise capacity. This study assessed the accuracy of dobutamine-atropine stress tetrofosmin SPECT as a means of diagnosing and localizing CAD. METHODS AND RESULTS: We studied 124 patients (mean age, 57+/-12 years; 88 men) with limited exercise capacity and suspected CAD with dobutamine (as much as 40 microg/kg/min)-atropine (as much as 1 mg) Tc-99m tetrofosmin SPECT. Resting images were acquired 24 hours after the stress test. Significant CAD was defined as 50% or greater luminal diameter stenosis in 1 or more major coronary arteries. Myocardial perfusion abnormalities (fixed and/or reversible defects) were detected in 70 of 88 patients with CAD and in 10 of the 36 patients without CAD (sensitivity = 80%, CI, 72 to 87; specificity = 72%, CI, 64 to 80; accuracy = 77%, CI, 70 to 85). Sensitivity and accuracy rates were higher by using the criterion of any defect than by using the criterion of reversible defects only (80% vs 51%, P<.0001; 77% vs 60%, P<.01, respectively). The sensitivity rate was higher in patients with multivessel CAD than in patients with single-vessel CAD (88% vs 63%, P<.05). Patients with multivessel CAD had a larger stress perfusion defect score (4.5+/-3.1 vs. 2.7+/-2.5, P<.01) than patients with single-vessel CAD. CONCLUSION: Dobutamine stress Tc-99m tetrofosmin SPECT is a useful method for the diagnosis and localization of CAD in patients with limited exercise capacity. Optimal accuracy of the technique is achieved by using both fixed and reversible perfusion abnormalities for the diagnosis of CAD in patients without an earlier myocardial infarction.
Atropine↗
[Use of harmonic echocardiographic contrast imaging and intravenous bolus of Levovist for evaluation of the left ventricle].
Harmonic imaging is a new imaging modality using nonlinear acoustic response, which is particularly sensitive for the particles of contrast agents. Our study was designed to compare the potential of harmonic echocardiographic imaging of the left ventricle using a contrast agent, Levovist to improve the detection of endocardium in patients with suboptimal image quality. 40 patients were studied using standard transthoracic apical views of the left ventricle patients using fundamental frequency and second harmonic frequency after and intravenous injection of 2.5 g Levovist. The quality of endocardial delineation in 16 standard segments was scored from 0 to 2. Endocardial visualization index was calculated as a mean of the scores to express overall diagnostic quality. Harmonic imaging with contrast significantly improved left ventricular endocardial border detection (endocardial visualization index at baseline 1.24 +/- 0.41, with contrast 1.63 +/- 0.38; p < 0.001). The improvement was qualitatively observed in all parts of the left ventricle: in apex (2.4 +/- 0.8), in the middle part (2.5 +/- 0.9) and slightly less in the basal part (2.1 +/- 1.1) as scored on a 0-3 scale. The number of invisible segments decreased from 124 (fundamental) to 50 in contrast harmonic mode. The persistence of the contrast enhancement, prolonged in harmonic as compared to fundamental imaging (284 +/- 136s vs 117 +/- 87s; p < 0.001) enabled convenient recording of all necessary views. Harmonic imaging after an intravenous injection of Levovist significantly improves the visualization of left ventricular endocardial border. Prolonged contrast effect after a single bolus enhances the pertinence of the method in clinical practice.
Adult↗