Bedside myocardial perfusion assessment with contrast echocardiography

Abstract

This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency medicine 2016. Other selected articles can be found online at http://www.biomedcentral.com/collections/annualupdate2016. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.

Fig. 1

Normal myocardial contrast perfusion echocardiograph: qualitative assessment. Ultrasound contrast infused until steady state achieved (SS – steady state). A ‘flash’ of high mechanical index ultrasound destroys the contrast microbubbles within the imaging beam. Assessment of myocardial perfusion is then made as the microbubbles return to the myocardium over subsequent cardiac cycles (1–6). Normal replenishment occurs over 5–6 cardiac cycles at rest, 2–3 cardiac cycles with stress

Fig. 2

Qualitative assessment of myocardial perfusion involves specification of a region of interest (ROI) classically corresponding to individual left ventricular myocardial segments

Fig. 3

Myocardial contrast perfusion echocardiography (MCPE) quantitative assessment. Regions of interest (ROI) are defined and rate of change in signal intensity assessed at end‐diastolic frames. The plateau signal intensity (A) is considered to represent the myocardial capillary blood volume. The rate of replenishment (β) of the microbubbles is considered as the velocity of blood. The product of A  ×  β is considered to represent the myocardial blood flow

Fig. 4

Takotsubo’s cardiomyopathy with microvascular dysfunction (arrows). Endocardial perfusion defect shown at 5 beats post flash in the apical region where transient apical hypokinesis was visualized. Coronary angiography confirmed normal vasculature and left ventriculography demonstrated apical ballooning