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We present the case of a 55-year-old man who developed massive pericardial effusion with tamponade within a 5-day period. During transthoracic two-dimensional echocardiographic examination, spontaneous echo contrast was visualized in pericardial effusion. A diagnosis of polymicrobial pyopericarditis was made when urgent pericardiocentesis revealed a significantly foul odor and purulent fluid that grew a culture of aerobes. After surgical drainage and appropriate antimicrobial therapy, this patient's pyopericarditis resolved. It was suggested that spontaneous echo contrast in pericardial effusion could be induced by non-gas-forming pyogenic cells.

Doppler echocardiography was performed during dobutamine stress test in 133 patients who had myocardial infarction. This investigation focused on the changes in the Doppler-derived left ventricular filling profile and hemodynamic measurements during ischemia. Patients were classified into two major groups on the basis of left ventricular ejection fraction (group 1, left ventricular ejection fraction > or = 40%, n = 66; group 2, left ventricular ejection fraction < 40%, n = 67) and then divided into the ischemic subgroup (1 A [n = 36] and 2A [n = 30]) and the scar subgroup (1 B [n = 36] and 2B [n = 31]) according to the presence or absence of dobutamine-induced myocardial ischemia. In group 1, the only Doppler echocardiographic measurement sensitive enough to differentiate ischemia was the corrected isovolumic relaxation time, which was significantly prolonged in group 1 A compared with group 1 B at peak stress (108 +/- 29 vs 82 +/- 30 msec, p = 0.005). The patients in group 2A had lower increases in stroke volume (-2% +/- 27% vs 22% +/- 33%, p = 0.002) and cardiac output (45% +/- 51 % vs 72% +/- 50%, p = 0.04) than those in group 2B, but larger increases in mitral peak early filling velocity (24% +/- 56% vs 0.9% +/- 37%, p = 0.02) and peak early to atrial velocity ratio (39% +/- 127% vs -24% +/- 38%, p = 0.01) than those in group 2B. The analysis of the changes that occurred in these parameters provides better insight into left ventricular diastolic and systolic function during dobutamine stress tests in patients after myocardial infarction.

Background: The diagnostic ability of dobutamine stress two-dimensional echocardiography is limited by the clarity of the echocardiographic image. In this study, left ventricular isovolumic relaxation time (IVRT) was modified and the effect of this modification on the diagnostic accuracy of dobutamine echocardiography (DE) in detecting ischemia was assessed., Methods: DE was performed in 59 subjects (34 and 25 in the control and patient group, respectively). The results were compared with coronary angiography and stress scintigraphy. We focused on the changes of the IVRT, the corrected IVRT which was the IVRT corrected for heart rate, and the modified IVRT which is the corrected IVRT modified by a new-designed equation., Results: These isovolumic relaxation variables shortened with the increment of dobutamine dosage and were markedly prolonged when ischemia developed. The sensitivity and specificity of DE were 84% and 74%. However, using the prolongation of corrected IVRT and modified IVRT as indicators of ischemia, the specificity increased (from 74% to 91% and to 94%, respectively), without a significant reduction in sensitivity (from 84% to 76% and to 84%, respectively). Patients with positive results for these variables, as compared with negative results, had a significant result of more ischemic segments and a tendency of more diseased vessels., Conclusion: The prolongation of these isovolumic relaxation variables during myocardial ischemia improves the diagnostic accuracy of DE and is also well correlated with the severity of ischemia.

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