Key result
The addition of intravenous Levovist significantly improved the Endocardial Border Delineation Index during fundamental imaging from 1.85 to 2.10 (p<0.001), achieving results nearly identical to tissue harmonic imaging.
Why the study?
Does harmonic imaging with or without Levovist improve endocardial border delineation in patients with poor quality echocardiographic images compared to fundamental imaging?
Observational (n=48)
Single-blind (observers blinded to clinical data)
Randomized sequence of imaging modes
No
Does harmonic imaging with or without Levovist improve endocardial border delineation in patients with poor quality echocardiographic images compared to fundamental imaging?
Absolute Event Rate: 2.1% vs 1.85%
p-value: p=<0.001
The addition of the contrast agent Levovist significantly improves endocardial border delineation in patients with poor acoustic windows, with the best results achieved using tissue or contrast harmonic imaging.
Levovist may improve endocardial border delineation in fundamental imaging; leaves open optimal contrast-harmonic strategy pending prospective trials.
Recent developments in tissue harmonic imaging and intravenous contrast agents have enhanced left ventricular endocardial border delineation (EBD). In a total of 48 patients with poor quality images, apical 4- and 2-chamber views were obtained with fundamental, tissue harmonic and contrast harmonic imaging with or without intravenous Levovist, an air-filled contrast agent. The left ventricle (LV) was divided into 12 segments, and the EBD of each segment was scored: (1) not visible, (2) barely visible, (3) well delineated. The EBD index (EBDI), defined as the sum of the endocardial scores divided by 12 was obtained for each patient. Of a total of 576 LV segments, 231 were scored as 1 by fundamental imaging and that number decreased to 125 segments by tissue harmonic imaging and 116 segments by fundamental imaging with Levovist. The number of segments scored as 1 decreased to 38 segments by tissue harmonic imaging with Levovist, and to 29 segments by contrast harmonic imaging with Levovist. The EBDI by fundamental imaging was 1.85+/-0.29, which improved significantly with the addition of Levovist (2.10+/-0.36, p<0.001) and was nearly identical to that by tissue harmonic imaging (2.15+/-0.32, p=NS). Tissue and contrast harmonic imaging with Levovist further enhanced the EBDI (2.43+/-0.26, 2.51+/-0.27, respectively). Levovist enhances EBD, even in the fundamental mode, to the level obtained with tissue harmonic imaging. Tissue harmonic and contrast harmonic imaging are the best modalities for enhancing EBD after Levovist injection.
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Yoshitani et al. (2002) conducted an observational in Poor quality echocardiographic images (n=48). Levovist vs. Fundamental imaging without Levovist was evaluated on Endocardial Border Delineation Index (EBDI) (p=<0.001). The addition of intravenous Levovist significantly improved the Endocardial Border Delineation Index during fundamental imaging from 1.85 to 2.10 (p<0.001), achieving results nearly identical to tissue harmonic imaging.
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