title: Simultaneous Assessment of Myocardial Perfusion, Wall Motion, and Deformation during Myocardial Contrast Echocardiography: A Feasibility Study.
abstract: OBJECTIVE
  Ultrasound contrast agents may be used for the assessment of regional wall motion and myocardial perfusion, but are generally considered not suitable for deformation analysis. The aim of our study was to assess the feasibility of deformation imaging on contrast-enhanced images using a novel methodology.
  
  
  RESULTS
  We prospectively enrolled 40 patients who underwent stress echocardiography with continuous intravenous infusion of SonoVue for the assessment of myocardial perfusion imaging with flash replenishment technique. We compared longitudinal strain (Lε) values, assessed with a vendor-independent software (2D CPA), on 68 resting contrast-enhanced and 68 resting noncontrast recordings. Strain analysis on contrast recordings was evaluated in the first cardiac cycles after the flash. Tracking of contrast images was deemed feasible in all subjects and in all views. Contrast administration improved image quality and increased the number of segments used for deformation analysis. Lε of noncontrast and contrast-enhanced images were statistically different (-18.8 ± 4.5% and -22.8 ± 5.4%, respectively; P < 0.001), but their correlation was good (ICC 0.65, 95%CI 0.42-0.78). Patients with resting wall-motion abnormalities showed lower Lε values on contrast recordings (-18.6 ± 6.0% vs. -24.2 ± 5.5%, respectively; P < 0.01). Intra-operator and inter-operator reproducibility was good for both noncontrast and contrast images with no statistical differences.
  
  
  CONCLUSIONS
  Our study shows that deformation analysis on postflash contrast-enhanced images is feasible and reproducible. Therefore, it would be possible to perform a simultaneous evaluation of wall-motion abnormalities, volumes, ejection fraction, perfusion defects, and cardiac deformation on the same contrast recording.
authors.affiliation: Department of Echocardiography, Royal Brompton Hospital, London, United Kingdom.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Zoppellaro
authors.affiliation: Department of Echocardiography, Royal Brompton Hospital, London, United Kingdom.
authors.forename: Lucia
authors.initials: L
authors.lastname: Venneri
authors.affiliation: Department of Echocardiography, Royal Brompton Hospital, London, United Kingdom.|Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom.|National Heart and Lung Institute (NHLI), Imperial College, London, United Kingdom.
authors.forename: Rajdeep S
authors.initials: RS
authors.lastname: Khattar
authors.affiliation: Department of Echocardiography, Royal Brompton Hospital, London, United Kingdom.
authors.forename: Wei
authors.initials: W
authors.lastname: Li
authors.affiliation: Department of Echocardiography, Royal Brompton Hospital, London, United Kingdom.|Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom.|National Heart and Lung Institute (NHLI), Imperial College, London, United Kingdom.
authors.forename: Roxy
authors.initials: R
authors.lastname: Senior
mesh_terms: D001783:Blood Flow Velocity; D003287:Contrast Media; D003326:Coronary Circulation; D004452:Echocardiography / Q000379:methods*; D055119:Elastic Modulus; D054459:Elasticity Imaging Techniques / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006334:Heart Function Tests / Q000379:methods; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D008297:Male; D008875:Middle Aged; D009038:Motion; D009200:Myocardial Contraction; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D010743:Phospholipids; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D013459:Sulfur Hexafluoride; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D016277:Ventricular Function, Left
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride
keywords: deformation imaging; myocardial contrast echocardiography; perfusion imaging; speckle tracking echocardiography