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Clinical Trial
. 2005 Jun 16:3:16.
doi: 10.1186/1476-7120-3-16.

Quantification of resting myocardial blood flow velocity in normal humans using real-time contrast echocardiography. A feasibility study

Siri Malm  1 , Sigmund Frigstad, Frode Helland, Kjetil Oye, Stig Slordahl, Terje Skjarpe
Affiliations
Clinical Trial

Quantification of resting myocardial blood flow velocity in normal humans using real-time contrast echocardiography. A feasibility study

Siri Malm et al. Cardiovasc Ultrasound. .

Abstract

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.

Conclusion: 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.

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Figures

Figure 1
Figure 1
The different coronary artery beds and their representation in myocardial segments of the LV apical views, given a balanced coronary circulation. LAD = left anterior descending artery; LCx = left circumflex artery; LV = left ventricle; RCA = right coronary artery. Courtesy of Asbjorn Stoylen, dept. of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
Figure 2
Figure 2
Some selected end-systolic images from destruction-replenishment sequences. A. 4-chamber view, B. 2-chamber view, C. Apical long-axis view.
Figure 3
Figure 3
ECG-triggered end-systolic analysis (EchoPAC PC™) of contrast replenishment in the LV apical long-axis view. Time-intensity plots are fitted to the exponential function A (1-e-β(t-t0)) + C. Typical attenuation artefact is seen in basal inferolateral wall. A = peak plateau signal intensity reflecting myocardial blood volume; B(C) = intercept at the origin; k (β) = rate of signal intensity rise (microbubble replenishment rate) reflecting myocardial blood flow velocity; LV = left ventricle.
See this image and copyright information in PMC

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