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European Journal of Echocardiography Advance Access published online on May 1, 2008

European Journal of Echocardiography, doi:10.1093/ejechocard/jen143
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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

Real-time three-dimensional myocardial contrast echocardiography: is it clinically feasible?

A. Bhan1, S. Kapetanakis1, B.S. Rana1, E. Ho1, K. Wilson1, P. Pearson1, S. Mushemi1, J. Deguzman1, J. Reiken1, M.D. Harden1, N. Walker1, P.G. Rafter2 and M.J. Monaghan1,*

1 Department of Non-Invasive Cardiology, King's College Hospital, Denmark Hill, London SE5 9RS, UK
2 Philips Medical Systems, Andover, MA, USA

Received 4 December 2007; accepted after revision 21 March 2008.

* Corresponding author. Tel: +44 207 346 3512; fax: +44 207 346 3489. E-mail address: mark.monaghan{at}kch.nhs.uk


   Abstract

Aims: Real-time 3D echocardiography (RT3DE) and 2D low mechanical index (LMI), contrast specific, myocardial perfusion imaging are now both accepted techniques. We evaluated the feasibility of an RT3DE LMI implementation in unselected patients.

Methods and results: Forty-six patients undergoing contrast enhanced dobutamine stress echo were imaged with novel 3D LMI power modulation software. All patients underwent contrast enhanced 2D and RT3DE acquisitions, in left ventricular opacification (LVO), and LMI perfusion modes. The data sets were evaluated segmentally for wall motion (WM) and myocardial contrast enhancement. Of the 736 evaluated segments, WM could be assessed in 726 (98.6%) of the 2D and 708 (96.2%) 3D segments (P = 0.007). Perfusion could be assessed in 721 (98%) of 2D and 701 (95.2%) of 3D segments (P = 0.006). Six hundred and sixty-one segments had normal WM and thickening in 2D and of these RT3DE demonstrated normal myocardial opacification in 77.2% of basal, 85% of mid, and 91.8% of apical segments. Thirty-four segments were akinetic, with no evidence of perfusion in 2D, and of these RT3DE revealed a perfusion defect in 31 (91%, P = NS).

Conclusion: LMI RT3DE evaluation of myocardial perfusion is feasible in most segments. It has the potential to accurately locate and possibly quantify perfusion defects.

Keywords: 3D echo; Contrast; Myocardial perfusion


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