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Contrast Echocardiography

Ultrasound contrast agents have improved the ability to depict the functions of the heart chambers. Today, it is even possible to view and analyze myocardial perfusion.

Ultrasound contrast agents have improved the ability to depict the functions of the heart chambers. Today, it is even possible to view and analyze myocardial perfusion. 
Contrast-enhanced ultrasound (CEUS) is one of the most advanced imaging techniques available and is used in specialist centers and cardiology departments. CEUS is an important addition to array of diagnostic tools for answering many questions in cardiology.
 
Tiny micro bubbles are administered intravenously and enter the minute capillaries in the lungs and then are distributed throughout the body. The bubbles (approx. 1 micrometer) contain contrast-agents which make them visible through advanced ultrasound technology. The micro-bubbles reflect and emit harmonic oscillations when exposed to ultrasound due to special properties in the contrast-agent. The results can be displayed very specifically.  Any sort of noise interference and the signals from the heart muscle or valves are also eliminated. This creates an image showing the distribution of bubbles in the blood, especially in the ventricle and the heart tissue itself. Thus, the visibility of the heart walls and spaces will be improved so that there is no significant difference in the determination of relevant cardiac volumes in comparison to cardiac MRI.
 
The ultrasound contrast agent colors the blood which is not actually visible in the ultrasound. 
This usually achieves a good result in patients from whom a satisfactory image cannot be obtained without a contrast agent. Therefore,   additional examinations are unnecessary.
Kontrastechokardiographie: Darstellung der Herzhölen
Contrast agent in left heart Chamber

If there is uncertainty, for example, the presence of a possible blood clot in the heart following a heart attack, the contrast echo can provide additional security. Unlike X-ray contrast agents, renal function here is not a contra-indication.Generally speaking, the contrast agents are well tolerated. The gas bubbles dissolve after a few minutes, and the gas is then exhaled through the lungs. Ultrasound contrast agents are an important help in the context of stress echocardiography. In obese patients ultrasound imaging can be especially difficult or impeded. In such cases, contrast agents can be used successfully. This is important when alternative methods (CT or MRI) are not desired or may not be technically feasible. They are also useful in the representation of myocardial perfusion. The blood flow in the finest blood vessels of the heart can be visualized using CEUS.

 

Publications on Contrast Echo (Isar Heart)

 

PubMed Results: 45

1.

Quantitative Myocardial Contrast Supine Bicycle Stress Echocardiography for Detection of Coronary Artery Disease.

Miszalski-Jamka T, Kuntz-Hehner S, Tiemann K, Karwat K, Kostkiewicz M.

Echocardiography. 2012 Dec 18. doi: 10.1111/echo.12064. [Epub ahead of print]

2.

4D phase contrast flow imaging for in-stent flow visualization and assessment of stent patency in peripheral vascular stents--a phantom study.

Bunck AC, Jüttner A, Kröger JR, Burg MC, Kugel H, Niederstadt T, Tiemann K, Schnackenburg B, Crelier GR, Heindel W, Maintz D.

Eur J Radiol. 2012 Sep;81(9):e929-37. doi: 10.1016/j.ejrad.2012.05.032. Epub 2012 Jul 6.

3.

Differentiation of malignant and benign cardiac tumors using 18F-FDG PET/CT.

Rahbar K, Seifarth H, Schäfers M, Stegger L, Hoffmeier A, Spieker T, Tiemann K, Maintz D, Scheld HH, Schober O, Weckesser M.

J Nucl Med. 2012 Jun;53(6):856-63. doi: 10.2967/jnumed.111.095364. Epub 2012 May 10.

4.

Transforming growth factor β₁ oppositely regulates the hypertrophic and contractile response to β-adrenergic stimulation in the heart.

Huntgeburth M, Tiemann K, Shahverdyan R, Schlüter KD, Schreckenberg R, Gross ML, Mödersheim S, Caglayan E, Müller-Ehmsen J, Ghanem A, Vantler M, Zimmermann WH, Böhm M, Rosenkranz S.

PLoS One. 2011;6(11):e26628. doi: 10.1371/journal.pone.0026628. Epub 2011 Nov 17.

5.

Cardiomyoplasty improves contractile reserve after myocardial injury in mice: functional and morphological investigations with reconstructive three-dimensional echocardiography.

Ghanem A, Röll W, Bostani T, Dewald O, Fleischmann BK, Stypmann J, Nickenig G, Tiemann K.

Cell Transplant. 2011;20(10):1621-8. doi: 10.3727/096368910X564049. Epub 2011 Mar 24.

6.

Cardioprotective effect of calcineurin inhibition in an animal model of renal disease.

Di Marco GS, Reuter S, Kentrup D, Ting L, Ting L, Grabner A, Jacobi AM, Pavenstädt H, Baba HA,Tiemann K, Brand M.

Eur Heart J. 2011 Aug;32(15):1935-45. doi: 10.1093/eurheartj/ehq436. Epub 2010 Dec 7.

7.

Vascular infarction by subcutaneous application of tissue factor targeted to tumor vessels with NGR-peptides: activity and toxicity profile.

Dreischalück J, Schwöppe C, Spieker T, Kessler T, Tiemann K, Liersch R, Schliemann C, Kreuter M, Kolkmeyer A, Hintelmann H, Mesters RM, Berdel WE.

Int J Oncol. 2010 Dec;37(6):1389-97.

8.

Myocardial contrast echocardiography enhances long-term prognostic value of supine bicycle stress two-dimensional echocardiography.

Miszalski-Jamka T, Kuntz-Hehner S, Schmidt H, Peter D, Miszalski-Jamka K, Hammerstingl C,Tiemann K, Ghanem A, Troatz C, Pasowicz M, Lüderitz B, Omran H.

J Am Soc Echocardiogr. 2009 Nov;22(11):1220-7. doi: 10.1016/j.echo.2009.07.020.

9.

Hemodynamic variables during stress testing can predict referral to early catheterization but failed to show a prognostic impact on emerging cardiac events in patients aged 70 years and older undergoing exercise (99m)Tc-sestamibi myocardial perfusion scintigraphy.

Bucerius J, Joe AY, Herder E, Brockmann H, Biermann K, Palmedo H, Tiemann K, Biersack HJ.

Int J Cardiovasc Imaging. 2009 Aug;25(6):569-79. doi: 10.1007/s10554-009-9461-2. Epub 2009 Apr 21.

10.

Echocardiographic assessment of global left ventricular function in mice.

Stypmann J, Engelen MA, Troatz C, Rothenburger M, Eckardt L, Tiemann K.

Lab Anim. 2009 Apr;43(2):127-37. doi: 10.1258/la.2007.06001e. Epub 2009 Feb 23. Review.

11.

Detection of coronary artery disease with perfusion stress echocardiography using a novel ultrasound imaging agent: two Phase 3 international trials in comparison with radionuclide perfusion imaging.

Senior R, Monaghan M, Main ML, Zamorano JL, Tiemann K, Agati L, Weissman NJ, Klein AL, Marwick TH, Ahmad M, DeMaria AN, Zabalgoitia M, Becher H, Kaul S, Udelson JE, Wackers FJ, Walovitch RC, Picard MH; RAMP-1 and RAMP-2 Investigators.

Eur J Echocardiogr. 2009 Jan;10(1):26-35. doi: 10.1093/ejechocard/jen321.

12.

Impact of previous myocardial infarction on the incremental value of myocardial contrast to two-dimensional supine bicycle stress echocardiography in evaluation of coronary artery disease.

Miszalski-Jamka T, Kuntz-Hehner S, Schmidt H, Miszalski-Jamka K, Hammerstingl C, Tiemann K, Ghanem A, Troatz C, Pasowicz M, Lüderitz B, Omran H.

Int J Cardiol. 2009 Jul 24;136(1):47-55. doi: 10.1016/j.ijcard.2008.04.072.

13.

High-resolution myocardial stress perfusion at 3 T in patients with suspected coronary artery disease.

Meyer C, Strach K, Thomas D, Litt H, Nähle CP, Tiemann K, Schwenger U, Schild HH, Sommer T.

Eur Radiol. 2008 Feb;18(2):226-33. Epub 2007 Sep 13.

15.

Potential risks of bone marrow cell transplantation into infarcted hearts.

Breitbach M, Bostani T, Roell W, Xia Y, Dewald O, Nygren JM, Fries JW, Tiemann K, Bohlen H, Hescheler J, Welz A, Bloch W, Jacobsen SE, Fleischmann BK.

Blood. 2007 Aug 15;110(4):1362-9. Epub 2007 May 4.

16.

Call for echo-contrast.

Tiemann K.

Int J Cardiovasc Imaging. 2007 Aug;23(4):491. Epub 2007 Apr 19. No abstract available.

17.

Triggered replenishment imaging reduces variability of quantitative myocardial contrastechocardiography and allows assessment of myocardial blood flow reserve.

Ghanem A, DeMaria AN, Lohmaier S, El-Sayed MA, Strachan M, Sommer T, Stypmann J, Tiemann K.

Echocardiography. 2007 Feb;24(2):149-58.

18.

Echocardiographic assessment of left ventricular mass in neonatal and adult mice: accuracy of different echocardiographic methods.

Ghanem A, Röll W, Hashemi T, Dewald O, Djoufack PC, Fink KB, Schrickel J, Lewalter T, Lüderitz B,Tiemann K.

Echocardiography. 2006 Nov;23(10):900-7.

19.

Persistence of iatrogenic atrial septal defect after pulmonary vein isolation--an underestimated risk?

Hammerstingl C, Lickfett L, Jeong KM, Troatz C, Wedekind JA, Tiemann K, Lüderitz B, Lewalter T.

Am Heart J. 2006 Aug;152(2):362.e1-5.

20.

Connexin31 cannot functionally replace connexin43 during cardiac morphogenesis in mice.

Zheng-Fischhöfer Q, Ghanem A, Kim JS, Kibschull M, Schwarz G, Schwab JO, Nagy J, Winterhager E, Tiemann K, Willecke K.

J Cell Sci. 2006 Feb 15;119(Pt 4):693-701. Epub 2006 Jan 31.

21.

In vitro and in vivo studies on continuous echo-contrast application strategies using SonoVue in a newly developed rotating pump setup.

Lohmaier S, Ghanem A, Veltmann C, Sommer T, Bruce M, Tiemann K.

Ultrasound Med Biol. 2004 Sep;30(9):1145-51.

22.

Defective epidermal barrier in neonatal mice lacking the C-terminal region of connexin43.

Maass K, Ghanem A, Kim JS, Saathoff M, Urschel S, Kirfel G, Grümmer R, Kretz M, Lewalter T,Tiemann K, Winterhager E, Herzog V, Willecke K.

Mol Biol Cell. 2004 Oct;15(10):4597-608. Epub 2004 Jul 28.

23.

Vascular flow and perfusion imaging with ultrasound contrast agents.

Bruce M, Averkiou M, Tiemann K, Lohmaier S, Powers J, Beach K.

Ultrasound Med Biol. 2004 Jun;30(6):735-43.

24.

[Determination of the renal blood flow in macro- and microcirculation by means of pulse inversion imaging].

Schlosser T, Veltmann C, Lohmaier S, Ehlgen A, Kuntz-Hehner S, Tiemann K, Becher H.

Rofo. 2004 May;176(5):724-30. German.

25.

Echoscintigraphy: a new imaging modality for the reduction of color blooming and acoustic shadowing in contrast sonography.

Schlosser T, Pohl C, Kuntz-Hehner S, Omran H, Becher H, Tiemann K.

Ultrasound Med Biol. 2003 Jul;29(7):985-91.

26.
27.

On the design of a capillary flow phantom for the evaluation of ultrasound contrast agents at very low flow velocities.

Veltmann C, Lohmaier S, Schlosser T, Shai S, Ehlgen A, Pohl C, Becher H, Tiemann K.

Ultrasound Med Biol. 2002 May;28(5):625-

28.

Transesophageal contrast echocardiography distinguishes a left atrial appendage thrombus from spontaneous echo contrast.

von der Recke G, Schmidt H, Illien S, Tiemann K, Becher H, Lüderitz B, Omran H.

Echocardiography. 2002 May;19(4):343-4. No abstract available.

29.

Ultrasonic imaging of organ perfusion with SH U 563A.

Bauer A, Becher H, Blomley M, Borges A, Cosgrove D, Leen E, Schlief R, Tiemann K.

Acad Radiol. 2002 May;9 Suppl 1:S46-51. No abstract available.

30.

Subendocardial steal effect seen with real-time perfusion imaging at low emission power during adenosine stress: replenishment M-mode processing allows visualization of vertical steal.

Tiemann K, Ghanem A, Schlosser T, Ehlgen A, Kuntz-Hehner S, Haushofer M, Bimmel D, Borovac M, Nanda NC, Omran H, Becher H.

Echocardiography. 2001 Nov;18(8):689-94.

31.

The impact of emission power on the destruction of echo contrast agents and on the origin of tissue harmonic signals using power pulse-inversion imaging.

Tiemann K, Veltmann C, Ghanem A, Lohmaier S, Bruce M, Kuntz-Hehner S, Pohl C, Ehlgen A, Schlosser T, Omran H, Becher H.

Ultrasound Med Biol. 2001 Nov;27(11):1525-33.

32.

Continuous-infusion contrast-enhanced US: in vitro studies of infusion techniques with differentcontrast agents.

Kuntz-Hehner S, Goenechea J, Pohl C, Schlosser T, Veltmann C, Lentz C, Lohmaier S, Ehlgen A, Omran H, Becher H, Tiemann K.

Radiology. 2001 Sep;220(3):647-54.

33.

Feasibility of the flash-replenishment concept in renal tissue: which parameters affect the assessment of the contrast replenishment?

Schlosser T, Pohl C, Veltmann C, Lohmaier S, Goenechea J, Ehlgen A, Köster J, Bimmel D, Kuntz-Hehner S, Becher H, Tiemann K.

Ultrasound Med Biol. 2001 Jul;27(7):937-44.

34.

Blood flow assessment by ultrasound-induced destruction of echocontrast agents using harmonic power Doppler imaging: which parameters determine contrast replenishment curves?

Köster J, Schlosser T, Pohl C, Lentz C, Lohmaier S, Veltmann C, Kuntz-Hehner S, Omran H, Lüderitz B, Becher H, Tiemann K.

Echocardiography. 2001 Jan;18(1):1-8.

35.

Real-Time Contrast Echo Assessment of Myocardial Perfusion at Low Emission Power: First Experimental and Clinical Results Using Power Pulse Inversion Imaging.

Tiemann K, Lohmeier S, Kuntz S, Köster J, Pohl C, Burns P, R T, Nanda NC, Lüderitz B, Becher H.

Echocardiography. 1999 Nov;16(8):799-809.

36.

Improvement in Endocardial Border Delineation Using Tissue Harmonic Imaging.

Becher H, Tiemann K, Schlosser T, Pohl C, Nanda NC, Averkiou MA, Powers J, Lüderitz B.

Echocardiography. 1998 Jul;15(5):511-518.

37.

Harmonic Power Doppler Contrast Echocardiography: Preliminary Clinical Results.

Becher H, Tiemann K, Schlief R, Lüderitz B, Nanda NC.

Echocardiography. 1997 Nov;14(6 Pt 1):63

38.

[Myocardial contrast echocardiography. Research instrument or already clinical application?].

Tiemann K, Becher H.

Z Kardiol. 2000 Oct;89(10):903-5. German.

39.

Stimulated acoustic emission: pseudo-Doppler shifts seen during the destruction of nonmoving microbubbles.

Tiemann K, Pohl C, Schlosser T, Goenechea J, Bruce M, Veltmann C, Kuntz S, Bangard M, Becher H.

Ultrasound Med Biol. 2000 Sep;26(7):1161-7.

40.

Incidence of left atrial thrombi in patients in sinus rhythm and with a recent neurologic deficit.

Omran H, Rang B, Schmidt H, Illien S, Schimpf R, Maccarter D, Kubini R, Von Der Recke G,Tiemann K, Becher H, Lüderitz B.

Am Heart J. 2000 Oct;140(4):658-62.

41.

Assessment of myocardial perfusion by power contrast imaging using a new echo contrast agent.

Nanda NC, Miller A, Puri VK, Fan PH, Tiemann K, Becher H, Main J, Batra S.

Echocardiography. 2000 Jul;17(5):457-61.

42.

Are microbubbles free flowing tracers through the Myocardium? Comparison of indicator-dilution curves obtained from dye dilution and echo contrast using harmonic power Doppler imaging.

Tiemann K, Schlosser T, Pohl C, Bimmel D, Wietasch G, Hoeft A, Likungu J, Vahlhaus C, Kuntz S, Nanda NC, Becher H, Lüderitz B.

Echocardiography. 2000 Jan;17(1):17-27.

44.

In vitro, animal, and human characterization of OPTISON infusions for myocardial contrastechocardiography.

Miller JJ, Tiemann K, Podell S, Doerr Stevens JK, Kuvelas T, Greener Y, Killam AL, Goenechea J, Dittrich HC, Becher H.

J Am Soc Echocardiogr. 1999 Dec;12(12):1027-34.

45.

Stimulated Acoustic Emission Nonbackscatter Contrast Effect of Microbubbles Seen with Harmonic Power Doppler Imaging.

Tiemann K, Becher H, Bimmel D, Schlief R, Nanda NC.

Echocardiography. 1997 Jan;14(1):65-70.

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