Contrast echocardiography: an update

Microvascular damage after coronary artery bypass surgery: assessment using dobutamine stress myocardial contrast echocardiography

BACKGROUND

Although dobutamine stress myocardial contrast echocardiography (DSMCE) has been widely used for the prediction of myocardial functional recovery, dynamic changes that occur at the microcirculatory level during stress have been studied limitedly. The objective of the present study was to use low-dose DSMCE to assess microvascular damage and predict myocardial functional recovery in coronary artery disease (CAD) patients receiving coronary artery bypass grafting.

METHODS

Forty-six CAD patients were subjected to low-dose DSMCE, as well as echocardiography and coronary computed tomography angiography before revascularization, 1 year after coronary artery bypass grafting. Dynamic changes occurring at the microcirculatory level during stress were analyzed for the ability to predict functional recovery. Quantitative assessment of functional recovery was determined using myocardial blood flow (MBF) via receiver operating characteristic curve analyses.

RESULTS

Patients who failed to recover had fewer changes in MBF (ΔMBF) at rest and with stress compared with the segments showing functional recovery. Semiquantitative changes (enhanced or reduced) of the myocardial perfusion score (ΔMPS) and quantitative changes in ΔMBF of stress myocardial contrast echocardiography enhanced the specificity of resting MPS and the sensitivity of wall motion scores (P < 0.05) for the prediction of functional recovery.

CONCLUSIONS

Specific stress ΔMBF more accurately reflected the extent of microvascular damage compared with wall motion scores and resting MPS. ΔMBF and ΔMPS under stress myocardial contrast echocardiography provided higher accuracy than wall motion scores and resting MPS in predicting functional recovery in CAD patients after revascularization.