title: Study of coronary flow reserve with intravenous use of microbubbles (contrast echocardiography) and adenosine: protocol for clinical application in patients suspected of having coronary heart disease.
abstract: OBJECTIVE
  To test the feasibility, safety and accuracy of the adenosine protocol in the study of myocardial perfusion with microbubbles contrast echocardiography.
  
  
  METHODS
  81 pts (64 male, 60+11 years) were submitted to contrast echocardiography with PESDA (sonicated solution of albumin 20%-1ml, dextrose 5%-12ml and deca-fluorobutane gas-8ml) to study the myocardial perfusion at rest and after bolus injection of adenosine (6 to 18mg) and to coronary angiography within 1 month each other. For each patient 3 left ventricle perfusion beds were considered (total of 243 territories). 208 territories were analyzed and 35 territories were excluded. PESDA was continuously infused (1-2ml/min), titrated for best myocardial contrast. Triggered (1:1) second harmonic imaging was used.
  
  
  RESULTS
  Coronary angiography showed 70 flow limiting (> 75%) lesions and 138 no flow limiting lesions. At rest an obvious myocardium contrast enhancement was seen in at least 1 segment of a territory in all patients. After adenosine injection an unquestionable further increase in myocardial contrast was observed in 136 territories (99%) related to no flow limiting lesions, lasting < 10 s, and a myocardial perfusion defect was detected in 68 territories (97%) related to flow limiting lesions. It was observed only 4 false results. There were no serious complications.
  
  
  CONCLUSIONS
  Myocardial perfusion study with PESDA and adenosine protocol is a practical, safe and accurate method to analyze the coronary flow reserve.
authors.affiliation: Serviço de Ecocardiografia, Hospital Pró-Cardíaco, Centro de Diagnostico Cardiovascular, Rio de Janeiro, Brazil. fmorcerf@cardiol.br
authors.forename: Fernando
authors.initials: F
authors.lastname: Morcerf
authors.forename: Alvaro
authors.initials: A
authors.lastname: Moraes
authors.forename: Marcia
authors.initials: M
authors.lastname: Carrinho
authors.forename: Hans J F
authors.initials: HJ
authors.lastname: Dohmann
mesh_terms: D000241:Adenosine; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D003287:Contrast Media; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000502:physiology*; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D004452:Echocardiography / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D012146:Rest; D014665:Vasodilator Agents
chemical_list: D003287:Contrast Media; D014665:Vasodilator Agents; D000241:Adenosine