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[Recent advances in echocardiographic diagnosis of ischemic heart disease]
1Department of Laboratory Technology, College of Medical Technology, Hokkaido University, Sapporo.
Insights
Recent advancements in echocardiography, including stress testing and new imaging technologies, have significantly improved the diagnosis and assessment of ischemic heart disease, enhancing visualization of myocardial blood flow and cardiac function.
Area of Science:
- Cardiology
- Medical Imaging
- Echocardiography
Background:
- Echocardiography's role in ischemic heart disease was limited before the 1990s, primarily assessing wall motion abnormalities and myocardial infarction complications.
- Technological progress has expanded echocardiography's applications in diagnosing and evaluating ischemic heart disease.
Purpose of the Study:
- To highlight recent technological advancements in echocardiography for ischemic heart disease.
- To discuss new applications in stress echocardiography, contrast agents, and 3D imaging.
Main Methods:
- Utilizing dobutamine stress echocardiography for diagnosing transient myocardial ischemia and assessing myocardial viability.
- Employing new contrast agents and ultrasound technologies like harmonic and gated intermittent imaging for enhanced visualization.
- Leveraging advances in three-dimensional (3D) technology for accurate left ventricular volume and ejection fraction measurements.
Main Results:
- Dobutamine stress echocardiography is now established for diagnosing ischemia and assessing viability.
- New contrast agents and imaging techniques improve visualization of myocardial blood flow and coronary microcirculation.
- 3D echocardiography allows precise volumetric measurements, crucial for remodeled left ventricles in ischemic patients.
Conclusions:
- Echocardiography has evolved significantly, offering expanded diagnostic capabilities for ischemic heart disease.
- Technological innovations enhance the noninvasive assessment of myocardial perfusion, viability, and cardiac structure.
- These advancements are vital for comprehensive evaluation and management of patients with ischemic heart disease.
Abstract:
Before the early 1990s, the diagnostic usefulness of echocardiography for ischemic heart disease had been relatively limited compared with that for other cardiac diseases such as valvular disease, congenital anomalies and cardiomyopathies. The principal role of echocardiography was to assess persistent regional wall motion abnormality as well as to detect complications of myocardial infarction. However, recent technological advances have created many newer applications of echocardiography in this field. One of the most important advances was seen in the field of stress echocardiography. Dobutamine stress echocardiography has become an established method of diagnosing transient myocardial ischemia due to coronary stenosis and assessing the myocardial viability of a persistently akinetic segment. More recently, several new contrast agents have been developed or will be available in the near future to visualize the blood stream within the left heart cavity and myocardial blood flow. Simultaneously, new ultrasound technologies including harmonic imaging and gated intermittent imaging have enhanced the selective visualization of contrast agents and will contribute to noninvasive imaging of coronary microcirculation. Harmonic imaging has also been shown to improve quality of B-mode image without a contrast agent and will play an important role in the clinical recognition of wall motion abnormality in patients with ischemic heart disease. Recent advances in three-dimensional technology have enabled accurate measurements of left ventricular volume and ejection fraction without any geometrical assumption, which may be especially important for the evaluation of ischemic patients who often have a deformed left ventricular cavity due to remodeling.