Quantification of resting myocardial blood flow velocity in normal humans using real-time contrast echocardiography. A feasibility study.
BACKGROUND
Real-time myocardial contrast echocardiography (MCE) is a novel method for assessing myocardial perfusion. The aim of this study was to evaluate the feasibility of a very low-power real-time MCE for quantification of regional resting myocardial blood flow (MBF) velocity in normal human myocardium.


METHODS
Twenty study subjects with normal left ventricular (LV) wall motion and normal coronary arteries, underwent low-power real-time MCE based on color-coded pulse inversion Doppler. Standard apical LV views were acquired during constant IV. infusion of SonoVue. Following transient microbubble destruction, the contrast replenishment rate (beta), reflecting MBF velocity, was derived by plotting signal intensity vs. time and fitting data to the exponential function; y (t) =A (1-e(-beta(t-t0))) + C.


RESULTS
Quantification was feasible in 82%, 49% and 63% of four-chamber, two-chamber and apical long-axis view segments, respectively. The LAD (left anterior descending artery) and RCA (right coronary artery) territories could potentially be evaluated in most, but contrast detection in the LCx (left circumflex artery) bed was poor. Depending on localisation and which frames to be analysed, mean values of beta were 0.21-0.69 s(-1), with higher values in medial than lateral, and in basal compared to apical regions of scan plane (p = 0.03 and p < 0.01). Higher beta-values were obtained from end-diastole than end-systole (p < 0.001), values from all-frames analysis lying between.


CONCLUSIONS
Low-power real-time MCE did have the potential to give contrast enhancement for quantification of resting regional MBF velocity. However, the technique is difficult and subjected to several limitations. Significant variability in beta suggests that this parameter is best suited for with-in patient changes, comparing values of stress studies to baseline.
Malm
Siri
S
Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway. siri.malm@ntnu.no
Frigstad
Sigmund
S
Helland
Frode
F
Oye
Kjetil
K
Slordahl
Stig
S
Skjarpe
Terje
T
D000328:Adult; D001783:Blood Flow Velocity; D003199:Computer Systems; D003326:Coronary Circulation; D004452:Echocardiography / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D008297:Male; D010743:Phospholipids; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013459:Sulfur Hexafluoride; D016276:Ventricular Function; D016277:Ventricular Function, Left / Q000502:physiology*
D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride