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CC BY-NC-ND 4.0 · Aktuelle Kardiologie 2025; 14(02): 160-170
DOI: 10.1055/a-2507-2120
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Kontrastechokardiografie: Indikationen, praktische Anwendung und aktuelle Evidenz

Contrast Echocardiography: Indications, Practical Aspects and Available Evidence
Christoph Hammerstingl
1   Innere Medizin, Internistische Intensivmedizin und Kardiologie, Eduardus-Krankenhaus gGmbH, Köln, Deutschland (Ringgold ID: RIN189781)
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Zusammenfassung

Ultraschallkontrastmittel ermöglichen eine direkte Darstellung des kardialen Blutflusses und dadurch eine schärfere Abgrenzung der kardialen Binnenstrukturen. Die europäischen und amerikanischen Leitlinien empfehlen, die Kontrastechokardiografie bei definierten Fragestellungen als First-Line-Diagnostik einzusetzen, wenn die 2D-Echokardiografie nicht konklusiv ist. Klassische Einsatzgebiete der Kontrastbildgebung sind die Optimierung der linksventrikulären Endokardabgrenzung in der linksventrikulären Funktions- und Ischämiediagnostik sowie der Evaluation unklarer intrakavitärer Raumforderungen. Die Implementation der Kontrastechokardiografie in einen standardisierten diagnostischen Algorithmus verschlankt die Abläufe. Die Behandlungsdauer wird verkürzt und Kosten werden eingespart. Therapierelevante Fragen werden ad hoc entschieden und Folgetherapien können geplant werden. In der Übersicht werden die häufigsten Einsatzgebiete der Kontrastechokardiografie aufgeführt sowie die Vor- und Nachteile möglicher diagnostischer Alternativen erläutert.

Abstract

Ultrasound contrast agents enable the direct visualization of the cardiac blood flow and thereby a better delineation of the endocardial borders. The European and the North American guidelines recommend the use of contrast echocardiography as first-line diagnostic, when the results from conventional 2D echocardiography remain ambiguous. Typically, contrast echocardiography is applied to optimize left ventricular (LV) border delineation for thrombus detection, LV-function measurement, or to identify myocardial ischemia during exercise. The implementation of contrast echocardiography in a standardized diagnostic algorithm reduces the patients’ treatment time and total therapeutic costs. It clarifies ambiguous results from 2D echocardiography and thereby enables ad hoc treatment planning. This review summarizes the most frequent indications of contrast echocardiography in daily routine and discusses this technique with diagnostic alternatives.

Was ist wichtig

  • Die Kontrastechokardiografie stellt eine wesentliche Erweiterung der konventionellen Echokardiografie dar und ermöglicht eine präzisere Beurteilung der kardialen Binnenstrukturen.

  • Durch den Einsatz lungengängiger Linksherz-Ultraschallkontrastmittel lassen sich intrakardiale Blutverteilungen direkt visualisieren, was insbesondere bei unklaren Befunden in der konventionellen 2D-Echokardiografie von diagnostischer Bedeutung ist.

  • Im Vergleich zu alternativen bildgebenden Verfahren wie der kardialen Magnetresonanztomografie (cMRT) oder Computertomografie (cCT) zeichnet sich die Kontrastechokardiografie durch eine hohe Verfügbarkeit, geringe Kosten und eine schnelle Durchführung aus. Sie sollte daher in der kardiologischen Diagnostik als First-Line-Option bei bestimmten Fragestellungen in Betracht gezogen werden.

  • Leitlinien der European Society of Cardiology (ESC) empfehlen den gezielten Einsatz dieser Methode, wenn herkömmliche bildgebende Verfahren keine eindeutigen Ergebnisse liefern.

Schlüsselwörter

Kontrastechokardiografie - Thrombendetektion - Endokardabgrenzung - leitliniengerechte Therapie

Keywords

contrast echocardiography - border detection - thrombus detection - guideline directed therapy


Publication History

Article published online:
02 April 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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