Journal
CIRCULATION
Volume 104, Issue 13, Pages 1550-1556Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/hc3801.095694
Keywords
echocardiography; perfusion; blood flow
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Background-Both intermittent triggered and real-time myocardial contrast echocardiography (MCE) have been proposed to detect impaired myocardial perfusion. We compared the ability of these 2 methods to quantify altered myocardial blood flow (MBF) and transmural distribution of MBF produced by graded coronary stenoses. Methods and Results-In 8 open-chest dogs, we created 4 graded left anterior descending coronary artery (LAD) stenoses: 3 levels of reduced adenosine hyperemia (non-flow-limiting at rest) and 1 grade of flow-limiting at rest. Real-time MCE was performed with SonoVue infusion using low-energy power pulse inversion (ATL) imaging, whereas ECG-gated intermittent triggered imaging used high energy at pulsing intervals from 1:1 to 1:10. LAD signal intensity (SI) was plotted versus time by real-time MCE and versus pulsing intervals by triggered MCE and was fitted to a 1-exponential function to obtain plateau SI (A) and the rate of SI rise (b). Visual detection of decreased opacification was equivalent by triggered and real-time MCE. Fluorescent microsphere-derived MBF ratio in LAD/left circumflex artery beds demonstrated close correlation with both real-time imaging (b, r=0.79; AXb, r=0.81) and triggered imaging (b, r=0.78; AXb, r=0.80). The endocardial/epicardial ratio of MBF in the LAD bed demonstrated closer correlation with the endocardial/epicardial ratios of b (r=0.71) and AXb (r=0.67) obtained by real-time than triggered imaging (b, r=0.42; AXb, r=0.52). Conclusions-Real-time and triggered MCE are equivalent in their ability to identify coronary stenosis and quantify altered MBF.
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