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Myocardial Perfusion

Key Reference Library on echocardiography and related topics - Last update : February 2010


Myocardial Contrast Echocardiography Enhances Long-Term Prognostic Value of Supine Bicycle Stress Two-Dimensional Echocardiography.

Tomasz Miszalski-Jamka, Stefanie Kuntz-Hehner, Harald Schmidt, Daniel Peter, Karol Miszalski-Jamka, Christoph Hammerstingl, Klaus Tiemann, Alexander Ghanem, Clemens Troatz, Mieczysław Pasowicz, Berndt Lüderitz, Heyder Omran.
MCE enhances the predictive power of supine bicycle stress 2DE and allows the risk stratification of patients with normal results on 2DE.
Reference: Journal of the American Society of Echocardiography, Volume 22, Issue 11, November 2009, Pages 1220-1227

Impact of previous myocardial infarction on the incremental value of myocardial contrast to two-dimensional supine bicycle stress echocardiography in evaluation of coronary artery disease.

Tomasz Miszalski-Jamka, Stefanie Kuntz-Hehner, Harald Schmidt, Karol Miszalski-Jamka, Christoph Hammerstingl, Klaus Tiemann, Alexander Ghanem, Clemens Troatz, Mieczysław Pasowicz, Berndt Lüderitz, Heyder Omran.
MCE enhances sensitivity and accuracy of 2DE in detection of obstructive CAD during supine bicycle stress. The incremental benefit of MCE is especially present in patients without previous MI.
Reference: International Journal of Cardiology, Volume 136, Issue 1, 24 July 2009, Pages 47-55

The Extent of Microvascular Damage During Myocardial Contrast Echocardiography Is Superior to Other Known Indexes of Post-Infarct Reperfusion in Predicting Left Ventricular Remodeling.

Galiuto L, Garramone B, Scarà A, Rebuzzi AG, Crea F, FESC, La Torre , Funaro S, Madonna M, Fedele F, Agati L; AMICI Investigators.
This is the first multicentric study on MCE in acute myocardial infarction, demonstrating, in 110 patients that microvascular integrity at MCE is the most important predictor of LV remodeling, as compared with persistent ST segment elevation and myocardial blush grade.
Reference : J Am Coll Cardiol. 2008 Feb 5;51(5):552-9

Effects of Left Bundle-Branch Block on Cardiac Structure, Function, Perfusion, and Perfusion Reserve: Implications for Myocardial Contrast Echocardiography Versus Radionuclide Perfusion Imaging for the Detection of Coronary Artery Disease.

Hayat SA, Dwivedi G, Jacobsen A, Lim TK, Kinsey C, Senior R, FESC.
In this paper, the authors demonstrate that left bundle branch block (LBBB) is associated with preserved flow but reduced coronary flow reserve. Interestingly, MCE appears superior to SPECT in the assessment of such flow changes, since SPECT is humpered by partial volume effect.
Reference : Circulation. 2008 Apr 8;117(14):1832-41. Epub 2008 Mar 31

Prognostic Value of Myocardial Viability Detected by Myocardial Contrast Echocardiography Early After Acute Myocardial Infarction

Dwivedi G, Janardhanan R, Hayat SA, Swinburn JM, Senior R, FESC.
In this interesting paper, the authors find that the extent of microvascular integrity at myocardial contrast echocardiography (MCE) is a powerful independent predictor of hard coronary events in patients after acute myocardial infarction. In fact, they demonstrate that contrast defect index <1.86 predicts survival in 99% of patients and contrast defect index <1.67 predicts survival or absence of recurrence of infarction in 95% of patients. Thus, ones more, MCE has demonstrated to have an important prognostic role after acute myocardiainfarction.
Reference : J Am Coll Cardiol. 2007 Jul 24;50(4):327-34. Epub 2007 Jul 6. 504 pp. 327-334

Myocardial contrast echocardiography for the detection of coronary artery stenosis: a prospective multicenter study in comparison with single-photon emission computed tomography

Jeetley P, Hickman M, Kamp O, Lang RM, FESC, Thomas JD, FESC, Vannan MA, Vanoverschelde JL, FESC, van der Wouw PA, Senior R, FESC.
In a prospective multicenter study MCE was compared with SPECT (a semiquantitative comparison) for the detection of coronary artery disease. In this population, with a high pretest probability of disease, there was no difference in the sensitivities of MCE and SPECT in the detection of CAD (84% vs. 82%) and both had similar specificities (56% vs. 52%), respectively. The authors contrast their results to a previous multicenter study that reported lower sensitivities and attribute their improved results to improved technology and expertise. There was no mention of patients excluded for image quality or segments/ regions that could not be visualized.
Reference: J Am Coll Cardiol. 2006 Jan 3;47(1):141-5

Quantitative adenosine real-time myocardial contrast echocardiography for detection of angiographically significant coronary artery disease

Malm S, Frigstad S, Torp H, Wiseth R, FESC, Skjarpe T.
55 consecutive patients, only 35 patients with a complete dataset. Although myocardial blood flow and myocardial blood flow velocity reserves can accurately identify significant coronary disease in selected patients, this technique is limited by imaging artifacts and timeconsuming analysis, and the diagnostic accuracy seems sufficient only for LAD stenosis.
Reference: J Am Soc Echocardiogr. 2006 Apr;19(4):365-72

Effect of coronary stenosis on adjacent bed flow reserve: assessment of microvascular mechanisms using myocardial contrast echocardiography.

Pacella JJ, Villanueva FS.
In an experimental study, epicardial flow (flow probe), total flow (epicardial and collateral contributions), flow through the microcirculation (vessels <10 µm [i.e., microspheres]), and regional myocardial blood volume (MCE) were measured separately to isolate the individual contributions to each flow territory. At baseline, LAD stenosis increased LCx epicardial flow without changing myocardial flow. During adenosine infusion, LCx flow reserve was significantly less during noncritical LAD stenosis than without stenosis. This result was associated with an increase in MCE-derived blood volume at end-systole. There was also a strong trend toward a negative linear relationship between stenosis severity and the magnitude of flow reserve reduction.
Reference: Circulation. 2006 Oct 31;114(18):1940-7

Collateral-flow measurements in humans by myocardial contrast echocardiography: validation of coronary pressure-derived collateral-flow assessment

Vogel R, Zbinden R, Indermühle A, Windecker S, FESC, Meier B, FESC, Seiler C, FESC.
Reference: Eur Heart J. 2006 Jan;27(2):157-65

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