title: Quantitative evaluation of regional endocardial visualisation with second harmonic imaging and contrast left ventricular opacification in heart failure patients.
abstract: OBJECTIVE
  Wall motion score index (WMSI) is an important prognostic indicator in heart failure (HF) patients but requires endocardial visualisation. This study evaluated the role tissue harmonic imaging (THI) and contrast opacification (LVO) for improving endocardial visualisation and the determination of WMSI in HF patients.
  
  
  RESULTS
  Thirty-one HF patients and 30 controls underwent apical echocardiography with fundamental imaging (FUND), THI and THI with contrast agent (Levovist). Visualisation and motion were graded in the six segments from each of the apical two and four chamber views. Both THI and LVO reduced the percentage of non-visualised segments (FUND 13.6%, THI 5.6%, LVO 2.8%, p=0.01) in the controls, but in HF patients, only THI improved visualisation (% segments not visualised FUND 9.7%, THI 3.5%, LVO 4.8%, p=0.06). The anterior and lateral walls were the least well visualised with FUND, but improved with LVO (anterior p=0.0026, lateral p=0.0003). No improvement was seen in the inferior wall (p=0.30) or septum (p=0.2). WMSI was similar by all methods and negatively correlated with ejection fraction (FUND r=-0.69, THI r=-0.74, LVO r=-0.77, all p<0.001).
  
  
  CONCLUSIONS
  THI improved endocardial visualisation in all subjects and LVO offered additional benefit in the controls, but not in HF patients. Regional endocardial visualisation was inconsistent. Thus, both patient factors and wall segment site need to be considered when using contrast agents for endocardial visualisation.
authors.affiliation: Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, PB 92 019, Auckland, New Zealand. g,whalley@auckland.ac.nz
authors.forename: Gillian A
authors.initials: GA
authors.lastname: Whalley
authors.forename: Greg D
authors.initials: GD
authors.lastname: Gamble
authors.forename: Helen J
authors.initials: HJ
authors.lastname: Walsh
authors.forename: Norman
authors.initials: N
authors.lastname: Sharpe
authors.forename: Robert N
authors.initials: RN
authors.lastname: Doughty
mesh_terms: D016022:Case-Control Studies; D003287:Contrast Media; D004452:Echocardiography / Q000379:methods*; D004699:Endocardium / Q000000981:diagnostic imaging*; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D011134:Polysaccharides; D013318:Stroke Volume; D016277:Ventricular Function, Left / Q000502:physiology
chemical_list: D003287:Contrast Media; D011134:Polysaccharides; C059891:SHU 508