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.
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.
Morcerf
Fernando
F
Serviço de Ecocardiografia, Hospital Pró-Cardíaco, Centro de Diagnostico Cardiovascular, Rio de Janeiro, Brazil. fmorcerf@cardiol.br
Moraes
Alvaro
A
Carrinho
Marcia
M
Dohmann
Hans J F
HJ
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
D003287:Contrast Media; D014665:Vasodilator Agents; D000241:Adenosine