411 - ECHOCARDIOGRAPHY IN PRACTICE: HOW CONTRAST ULTRASOUND AND FUTURE INNOVATIONS IMPACT THE EVERYDAY CARDIOLOGIST

Chair(s)

• DK

  Dominique Kushneriuk, MD FRCPC

  Cardiology resident

Presenter(s)

• HB

  Harald Becher, MD FRCPC

  Professor
  University of Alberta
• HL

  Howard Leong-Poi, MD FRCPC

  Professor
  St. Michael's Hospital
• MP

  Maude Page, MD FRCPC

Early Career(s)

• DB

  Daniel Belliveau, MD FRCPC

  Assistant Professor
  Dalhousie Medicine Division of Cardiology
• DK

  Dominique Kushneriuk, MD FRCPC

  Cardiology resident
• MP

  Maude Page, MD FRCPC
• RW

  Rachel Wamboldt, MD

Trainee(s)

• EL

  Evan Losier, MD FRCPC
• 

  Jeffrey Yim, MD

  Cardiology Resident
  University Of British Columbia
  University of British Columbia

Moderator(s)

• 

  Sharon Mulvagh, MD FRCPC FASE FACC FAHA

  Cardiologist
  Dalhousie University
  Dalhousie University

Planning Committee Member(s)

• DB

  Daniel Belliveau, MD FRCPC

  Assistant Professor
  Dalhousie Medicine Division of Cardiology
• 

  Robin Ducas, MD, FRCPC, DRCPSC

  Dr.
  University of Manitoba
  University of Manitoba
• HL

  Howard Leong-Poi, MD FRCPC

  Professor
  St. Michael's Hospital
• EL

  Evan Losier, MD FRCPC
• RW

  Rachel Wamboldt, MD
• 

  Jeffrey Yim, MD

  Cardiology Resident
  University Of British Columbia
  University of British Columbia

Workshop Description: Contrast enhanced ultrasound using ultrasound enhancing agents (UEA) has been available for over two decades, and although the need has increased, due to increasing rates of obesity, underutilization of this valuable and safe technique persists in Canada due to lack of awareness, skills and training. It is estimated that 10-30% of echocardiograms are technically challenging or inadequate; this rate is greater in specialty echocardiographic applications, such as stress echocardiography, where complete visualization of the endocardial border is essential to determine presence of ischemia.

Evidence-based applications of UEA in echocardiography include:
1) Quantitative assessment of left ventricular volumes, left ventricular ejection fraction (LVEF) and regional wall motion (RWM), both during rest and stress echocardiography
2) Differentiation of intracardiac masses, LV apical abnormalities and left atrial appendage thrombus
3) Assessment of myocardial perfusion

UEAs improve the feasibility and accuracy of echocardiographic performance and diagnosis when cardiac structures cannot otherwise be clearly visualized. UEAs are Health Canada and FDA-approved agents to improve the diagnostic yield of suboptimal echocardiography through left ventricular opacification (LVO) and improved endocardial border definition (EBD). Suboptimal imaging is more likely to occur in the setting of critical illness including mechanical ventilation, obesity, chronic obstructive pulmonary disease.

UEAs are comprised of phospholipid- or albumin-shelled gas-filled microbubbles smaller than red blood cells, permitting transpulmonary passage and appearance in the left ventricle (LV). When insonated by the ultrasound beam, UEAs oscillate between compression and expansion, emitting an ultrasound signal that can be detected to improve EBD. Advancements in ultrasound imaging to detect UEAs have optimized LVO, EBD and myocardial perfusion imaging, which can be used for determination of ischemia and characterization of intracavitary masses. Beyond diagnostic imaging, sonothrombolysis involves therapeutic application of UEA’s to improve epicardial coronary artery and microcirculatory reperfusion in ACS.