Myocardial contrast echocardiography demonstrates myocardial hypoperfusion in the LAD territory in patients with acute chest pain at rest--a prospective study using power Doppler harmonic imaging with intravenous bolus application.

AIMS

Using a previously published algorithm we hypothesize that myocardial contrast echocardiography (MCE) with power Doppler harmonic imaging (PDHI) is able to detect regional hypoperfusion within the territory of the left anterior descending artery (LAD) using intravenous (i.v.) injection of contrast in patients (pts) with coronary syndrome at rest.

METHODS AND RESULTS

Forty-seven consecutive patients (pts) were prospectively evaluated using a standardized i.v. bolus application of OPTISON. MCE data were acquired within 2 h before angiography. Cut-off Doppler intensity (DI)-values determined in the apical, mid, and basal septum were distinguished between normal and hypoperfused myocardium (e.g. 23.5 and 22.5 dB for maximum DI of the apical or mid-septum triggering on every third heart cycle). Seventeen of 42 pts were classified as normal and the remaining 25 pts as pathologic (10 of these 25 pts had elevated troponines). Angiography detected open vessels or TIMI-III-flow in 15 pts of the normal MCE group, significant stenosis (>70%) or reduced TIMI-flow in 22 pts of the pathologic MCE group. The highest sensitivities (83-92%) were found in the apical septum.

CONCLUSION

Assessment of the myocardial perfusion deficits in the LAD territory of pts with acute coronary syndrome is feasible with MCE with PDHI using an i.v. bolus protocol.