Detection of Myocardial Perfusion in Multiple Echocardiographic Windows With One Intravenous Injection of Microbubbles Using Transient Response Second Harmonic Imaging

• Published in: Journal of the American College of Cardiology 1997-03, Vol.29 (4), p.791-799
• Main Authors: Porter, Thomas R., Li, Shouping, Kricsfeld, David, Armbruster, Robert W.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Cardiovascular system; Contrast Media; Dipyridamole; Echocardiography - methods; Exercise Test; Female; Fluorocarbons; Heart - diagnostic imaging; Humans; Image Enhancement; Injections, Intravenous; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Observer Variation; Sonication; Technetium Tc 99m Sestamibi; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon; Ultrasonic investigative techniques; Vasodilator Agents
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/S0735-1097(96)00575-X

Objectives. The purpose of this study was to prove that transient response harmonic imaging could detect normal and abnormal myocardial perfusion in multiple echocardiographic windows with one intravenous injection of microbubbles in humans. Background. Myocardial ultrasound contrast can be produced from intravenous perfluorocarbon-exposed sonicated dextrose albumin, and ultrasound can be significantly improved by briefly suspending the interval between frame rates. Whether this contrast can noninvasively quantify myocardial perfusion in humans is unknown. Methods. In 28 patients, harmonic transient response imaging was used to image the heart in multiple different imaging planes after one intravenous injection of ultrasound contrast agent. Twenty-five of these 28 patients had a repeat injection during dipyridamole stress. In the primary view, the ultrasound transmission rate was one frame per cardiac cycle; in secondary and tertiary views, the transmission rate was once every multiple cardiac cycles. Regional myocardial contrast was visually assessed and quantified off-line. Quantitative rest thallium and dipyridamole stress sestamibi imaging was also performed. Results. Perfusion abnormalities were evident in the secondary and tertiary views only with one frame every multiple cardiac cycles. Regional peak myocardial videointensity (PMVI) correlated closely with regional tracer uptake in individual patients both at rest (r = 0.84) and during stress (r = 0.88). A PMVI ratio (abnormal region divided by the region with highest nuclear uptake)