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European Journal of Echocardiography Advance Access originally published online on August 22, 2008
European Journal of Echocardiography 2009 10(2):250-255; doi:10.1093/ejechocard/jen217
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org.

Comparison of myocardial contrast echocardiography derived myocardial perfusion reserve with invasive determination of coronary flow reserve{dagger}

S. Michelle Bierig*, Peter Mikolajczak, Steven C. Herrmann, Nicole Elmore, Morton Kern and Arthur J. Labovitz

Echocardiography Laboratory, St Louis University School of Medicine, FDT-14, St Louis, MO 63110, USA

Received 21 March 2007; accepted after revision 27 July 2008; online publish-ahead-of-print 22 August 2008.

* Corresponding author. Tel: +1 314 577 8889. E-mail address: bierigsm{at}slu.edu


  Abstract

Aims: Invasive measurements of coronary flow reserve (CFR) by Doppler flow wire are an established method for determining coronary blood flow physiology. Myocardial contrast echocardiography (MCE) is a potential non-invasive method for quantifying myocardial blood flow (MBF). However, few studies have compared MCE-derived myocardial perfusion reserve (MPR) with Doppler flow wire-derived CFR, measured simultaneously in human subjects. This study aimed to correlate MCE-derived MPR with Doppler flow wire-derived CFR.

Methods and results: Ten patients with at least two angiographically normal coronary arteries underwent simultaneous invasive Doppler flow wire measurements and MCE imaging at rest and at peak hyperaemia. Hyperaemia was induced by intravenous adenosine infusion. Doppler-derived CFR was calculated as the ratio of hyperaemic to baseline average peak red blood cell velocity. MPR was calculated as the hyperaemic to baseline ratio of the following parameters: myocardial blood volume (MBV), myocardial microbubble velocity (MMV), and MBF. MCE was performed using real-time and triggered imaging with contrast infused intravenously by bolus and continuous methods. Regardless of whether the contrast was infused by bolus or continuous methods, Doppler flow wire-derived CFR had a stronger correlation with MPR derived by MBV (r = 0.8, P = 0.05) than with MPR derived by microbubble velocity (r = 0.3, P > 0.05) or MBF (r = 0.4, P > 0.05). Real-time imaging with continuous infusion provided better correlation with CFR than triggered imaging methods or bolus administration.

Conclusion: Myocardial perfusion reserve derived by real-time infusion MBV measurements correlates with Doppler flow wire-derived CFR. Therefore, MPR may be a potential surrogate for Doppler flow wire-derived CFR in patients with angiographically normal coronary arteries.

Keywords: Myocardial contrast echocardiography; Myocardial perfusion reserve; Coronary flow reserve; Doppler flow wire

{dagger} Presented in part at the American College of Cardiology Scientific Sessions 2003.


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