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55 yr old man referred for investigation of chest pain. Smoker, BP
Dobutamine stress & myocardial contrast echocardiography performed
Normal wall motion (and therefore by definition perfusion) at rest
Abormal Example - STRESS
AP4C
AP2C
AP3C
Note:
At peak stress, widespread perfusion defects in all apical segments, septum and anterior wall despite only the apical septum being hypokinetic.
Freeze frames showing perfusion defects
AP4C
AP2C
AP3C
Note:
These are still frames from 1 second after flash destruction. Note the heart rate of 122-126bpm. The yellow arrows depict clear perfusion defects in all three apical views.
Abormal Example - Angiogram
Note:
Thus by wall motion criteria, there was only 1/17 ischaemic segments (apical septum)
But by perfusion, there were 6/17 ischaemic segments (true apical cap, apical septum, apical lateral, apical inferior, apical anterior and mid anterior)
Coronary angiography revealed an entirely occluded LAD coronary artery, thus proving the incremental value of MCE over wall motion in this case
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Our mission: To reduce the burden of cardiovascular disease.