Determinants of myocardial hypoperfusion analyzed for the interventricular septum using power Doppler harmonic imaging with contrast echocardiography in humans: a methodologic approach for clinical practice

Real-time myocardial contrast stress echocardiography using bolus application

In myocardial contrast echocardiography (MCE), power modulation technique may quantify myocardial perfusion in real-time. However, constant infusion of the contrast agent (CA) complicates handling. This pilot study sought for the clinical feasibility of quantitative MCE by a CA bolus application during Adenosine stress echocardiography to diagnose coronary artery disease (CAD). Twenty-four consecutive patients (pts) with contemporary coronary angiography underwent rest and maximum Adenosine stress. Signal intensity could be calculated in 316/348 left ventricular (LV) segments (91%) (18-segment model). At rest, gamma-variate (alpha) as well as saturation function (beta) was not significantly different in healthy men (n = 268) as well as CAD pts (n = 48) (alpha: 0.34 s(-1) versus 0.40 s(-1), n.s.; beta: 0.31 s(-1) versus 0.35 s(-1), n.s.). During Adenosine infusion both values increased in healthy men (alpha: 0.34 +/- 0.37 s(-1) versus 0.44 +/- 0.45 s(-1), p < 0.05; beta: 0.31 +/- 0.33 s(-1) versus 0.40 +/- 0.40 s(-1), p < 0.01), but not in CAD (alpha: 0.40 +/- 0.35 s(-1) versus 0.29 +/- 0.29 s(-1), n.s.; beta: 0.35 +/- 0.32 s(-1) versus 0.27 +/- 0.30 s(-1), n.s.). Sensitivity of alpha/beta reserve <or=1 was 65%/67% (specificity 66%/67%) and improved to 88% in both if also wall motion analysis was considered (specificity 59%/65%). A very high negative predictive value of 96%/97% favours the method for excluding CAD. Bolus administration of CA is feasible in quantitative real-time MCE. However, additional consideration of wall motion analysis is required for reasonable sensitivity. Very high negative predictive values favour the potential of the method in excluding the diagnosis. Further need of research work may be encouraged by those findings.

Usefulness of myocardial perfusion echocardiography to identify obstructive coronary artery disease in patients with abnormal ventricular septal motion

Twenty-three patients who had septal wall motion abnormalities and who underwent angiography within 2 weeks were evaluated by myocardial perfusion echocardiography. Mean perfusion score (plateau video intensity times the wash-in rate) was lower in segments that were supplied by obstructed coronary arteries in real time (7.5 vs 22.6 dB/s, p <0.005) and with end-systolic triggering (8.6 vs 20.9 dB/s, p <0.001). Lower mean septal perfusion scores (<12 dB/s) were seen in 14 of 16 patients who had obstructive septal coronary artery disease, and normal mean septal perfusion scores were seen in 6 of 7 patients who did not have obstructive septal coronary artery disease.

Intravenous myocardial contrast echocardiography during angioplasty

Myocardial contrast echocardiography (MCE) using power Doppler harmonic imaging (PDHI) has been reported to document regional myocardial perfusion. Two case reports demonstrate the potential of intravenous myocardial contrast echocardiography during angioplasty.