Evaluation of myocardial perfusion with grey-scale ultra-harmonic and multiple-frame triggering. The need for quantification.
OBJECTIVE
Contrast echocardiography has been recently introduced as a new technique for evaluating myocardial perfusion in a qualitative basis. The objective of this study was to test whether a visual subjective evaluation of myocardial perfusion by myocardial contrast echocardiography adequately matches the data obtained with an off-line quantification of myocardial perfusion.


METHODS
Sixty-one myocardial segments were evaluated by myocardial contrast echocardiography with Ultra-harmonic and Multiframe Triggering in 11 patients 3-7 days after an anterior myocardial infarction, using SH-U 563A (Levovistâ, Schering AG, Berlin, Germany) as contrast agent. Myocardial perfusion was classified as grade 1 (absent), 2 (patchy or incomplete) and 3 (complete) in each segment. The quantitative analysis was performed off-line by a different investigator blinded to the qualitative evaluation, using a commercially available software. The quantitative data on grey-scale obtained were compared between grade 1, 2 and 3 segments.


RESULTS
Of the 61 segments, 45 (73.8%) were classified as grade 3, whereas the remaining 16 (26.2%) were considered to be abnormally perfused (grade 2: n=12, 19.6%; grade 1: n=4, 6.6%). Segments with grade 1 perfusion had a significantly higher grey-scale value (123.6 +/- 41.3 vs. 70.1 +/- 34.3, p=0.004). However, there were no significant differences between segments with perfusion grade 2 and 3 (76.8 +/- 33.2 vs. 68.3 +/- 34.8, p=0.452).


CONCLUSIONS
Qualitative assessment of myocardial perfusion by Ultra-harmonic and Multiframe Triggering is of limited value, since only myocardial segments with absent perfusion may be reliably identified. This findings support the need of quantification in the evaluation of myocardial perfusion by contrast echocardiography.
Moreno
Raúl
R
Laboratory of Echocardiography, Cardiovascular Institute, Hospital Clinico San Carlos, Plaza Cristo Rey, s/n, Madrid, Spain.
Zamorano
José L
JL
Serra
Viviana
V
Almería
Carlos
C
Perez de Isla
Leopoldo
L
Rodrigo
Jose-Luis
JL
Mataix
Luis
L
Herrera
Dionisio
D
Aubele
Adalia
A
De Marco
Esther
E
Sánchez-Harguindey
Luis
L
Macaya
Carlos
C
D000368:Aged; D003287:Contrast Media; D003326:Coronary Circulation; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging*; D009206:Myocardium / Q000378:metabolism*; D011134:Polysaccharides; D012039:Regional Blood Flow
D003287:Contrast Media; D011134:Polysaccharides; C059891:SHU 508