[Regional myocardial perfusion in ischemic heart disease assessed by myocardial contrast echocardiography].

Myocardial contrast echocardiography is a new cardiovascular imaging technique that can be used to evaluate regional myocardial perfusion. Regional myocardial perfusion was studied in 12 patients with normal coronary arteries, 14 patients with old myocardial infarction, four patients with acute myocardial infarction, and 15 patients with effort angina. Conventional two-dimensional echo imaging was obtained during intracoronary injections of relatively small volumes (2 ml) of agitated Urografin-76. The echo intensities were measured before and after injecting contrast agents and the subtraction images were composed by a high-speed image processor (NEXUS 6400). Clear myocardial images were obtained in 10 of 12 the patients with normal coronary arteries, and they reflected well the epicardial arterial architecture by coronary angiography. In cases of old myocardial infarction, the infarcted areas appeared as contrast defects in seven and as slightly enhanced areas in three of the 10 patients. In cases of acute myocardial infarction, contrast defect areas in the myocardial images were less in two cases of successful early coronary thrombolysis or percutaneous transluminal coronary angioplasty (PTCA). However, contrast defects remained unchanged despite good recanalization in one case of delayed PTCA. In cases of effort angina, anginal attacks were successfully induced by rapid atrial pacing in six of the 15 patients. In four of the six patients, contrast enhancement in myocardial imaging during anginal attack decreased more in the endocardial than in the epicardial myocardium, possibly reflecting subendocardial ischemia. It is concluded that this technique can identify regional myocardial perfusion, which is not revealed by coronary angiography, and it is therefore useful for the clinical analysis of ischemic heart disease.