title: Is real time contrast echocardiography useful for assessment of the right ventricular morphology, function, and perfusion?
abstract: BACKGROUND
  Contrast-enhanced echocardiography (CE) is recommended to assess left ventricular function and perfusion but is rarely used to assess the right ventricle (RV). We used CE to assess RV function and perfusion and evaluated whether RV perfusion defects varied in different patient groups with RV failure due to pressure overload.
  
  
  METHODS
  We studied 17 patients with acute pulmonary embolism (PE), 19 patients with chronic pulmonary arterial hypertension (CPH), and 7 healthy volunteers. The examination included RV opacification (RVO) and myocardial CE. RV end-diastolic area (RVEDA), RV end-systolic area (RVESA), fractional area change (FAC), and wall-motion score index (WMSI) were assessed before and after contrast agent administration. Perfusion was evaluated qualitatively and quantitatively.
  
  
  RESULTS
  RVEDA, RVESA, FAC, and regional contractility were comparable before and after contrast agent injection. Significant perfusion defects were seen in PE and CPH (18/39 segments and 37/51 segments, respectively, vs. 0/21 segments in healthy volunteers; P < 0.0001). Wall-perfusion score index (WPSI) was higher in PE and CPH compared to healthy volunteers (1.5 ± 0.3 and 1.8 ± 0.4 vs. 1.0 ± 0.0; P = 0.02 and P = 0.0003, respectively). Linear correlations were noted between WMSI, FAC and WPSI (r = 0.5, P = 0.014 and r = -0.55, P = 0.005, respectively). Quantitative perfusion assessment revealed perfusion defects in the apical segment in the PE group. The mean region of interest value was insignificantly reduced in PE and CPH groups.
  
  
  CONCLUSIONS
  Contrast-enhanced echocardiography is feasible and may be useful for RVO and perfusion assessment in patients with RV dysfunction due to systolic overload. The SonoVue contrast agent was well tolerated by stable patients with PE and CPH.
authors.affiliation: Department of Cardiology, Medical University of Bialystok, Bialystok, Poland.
authors.forename: Marta
authors.initials: M
authors.lastname: Kamińska
authors.affiliation: Department of Cardiology, Medical University of Bialystok, Bialystok, Poland.
authors.forename: Bożena
authors.initials: B
authors.lastname: Sobkowicz
authors.affiliation: Department of Cardiology, Medical University of Bialystok, Bialystok, Poland.
authors.forename: Robert
authors.initials: R
authors.lastname: Sawicki
authors.affiliation: Department of Cardiac Surgery, Medical University of Bialystok, Bialystok, Poland.
authors.forename: Janina
authors.initials: J
authors.lastname: Lewkowicz
authors.affiliation: Department of Cardiology, Medical University of Bialystok, Bialystok, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Tomaszuk-Kazberuk
authors.affiliation: Philips Healthcare, Warsaw, Poland.
authors.forename: Renata
authors.initials: R
authors.lastname: Glińska
authors.affiliation: Department of Cardiology, Medical University of Bialystok, Bialystok, Poland.
authors.forename: Włodzimierz J
authors.initials: WJ
authors.lastname: Musiał
mesh_terms: D000368:Aged; D003287:Contrast Media; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging* / Q000503:physiopathology; D007089:Image Enhancement; D008297:Male; D008875:Middle Aged; D010743:Phospholipids; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000503:physiopathology; D015203:Reproducibility of Results; D013459:Sulfur Hexafluoride; D014463:Ultrasonography; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000503:physiopathology
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride
keywords: acute pulmonary embolism; chronic pulmonary arterial hypertension; contrast-enhanced echocardiography; right ventricle