University of Nebraska Medical Center, Omaha, NE 68198-8865, USA.
Circ Cardiovasc Imaging. 2011 Nov;4(6):628-35. doi: 10.1161/CIRCIMAGING.111.966341. Epub 2011 Sep 23.
Real-time myocardial contrast echocardiography permits the detection of myocardial perfusion abnormalities during stress echocardiography, which may improve the accuracy of the test in detecting coronary artery stenoses. We hypothesized that this technique could be used after a bolus injection of the selective A2A receptor agonist regadenoson to rapidly and safely detect coronary artery stenoses.
In 100 patients referred for quantitative coronary angiography, real-time myocardial contrast echocardiography was performed during a continuous intravenous infusion of 3% Definity at baseline and at 2-minute intervals for up to 6 minutes after a regadenoson bolus injection (400 μg). Myocardial perfusion was assessed by examination of myocardial contrast replenishment after brief high mechanical index impulses. A perfusion defect was defined as a delay (>2 seconds) in myocardial contrast replenishment in 2 contiguous segments. Wall motion was also analyzed. The overall sensitivity/specificity/accuracy for myocardial perfusion analysis in detecting a >50% diameter stenosis was 80%/74%/78%, whereas for wall motion analysis it was 60%/72%/66% (P<0.001 for differences in sensitivity). Sensitivity for myocardial perfusion analysis was highest on images obtained during the first 2 minutes after regadenoson bolus (P<0.001 compared with wall motion), whereas wall motion sensitivity was highest at the 4-to-6-minute period after the bolus. No significant side effects occurred after regadenoson bolus injection.
Regadenoson real-time myocardial contrast echocardiography appears to be a feasible, safe, and rapid noninvasive method for the detection of significant coronary artery stenoses.
实时心肌对比超声心动图可在应激超声心动图期间检测到心肌灌注异常，这可能会提高检测冠状动脉狭窄的测试准确性。我们假设，这种技术可以在选择性 A2A 受体激动剂雷卡地诺松的推注后使用，以快速安全地检测冠状动脉狭窄。
在 100 名因定量冠状动脉造影而就诊的患者中，在 3%的 Definity 连续静脉输注期间，在雷卡地诺松推注（400μg）后立即进行实时心肌对比超声心动图检查，并在 2 分钟间隔内进行，最多进行 6 分钟。通过短暂的高机械指数脉冲后检查心肌对比再填充来评估心肌灌注。灌注缺损定义为 2 个连续节段的心肌对比再填充延迟（>2 秒）。还分析了壁运动。心肌灌注分析检测 >50%直径狭窄的总体敏感性/特异性/准确性为 80%/74%/78%，而壁运动分析为 60%/72%/66%（差异的敏感性 P<0.001）。雷卡地诺松推注后 2 分钟内获得的图像上的心肌灌注分析敏感性最高（与壁运动相比，P<0.001），而壁运动的敏感性在推注后 4 至 6 分钟最高。雷卡地诺松推注后无明显副作用。
雷卡地诺松实时心肌对比超声心动图似乎是一种可行、安全、快速的无创方法，可用于检测严重的冠状动脉狭窄。
