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European Journal of Echocardiography Advance Access published online on June 23, 2009
European Journal of Echocardiography, doi:10.1093/ejechocard/jep090
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Quantitative contrast stress echocardiography in assessment of restenosis after percutaneous coronary intervention in stable coronary artery disease

Mai Tone Lønnebakken*, Eva M. Staal, Øyvind Bleie, Elin Strand, Ottar K. Nygård and Eva Gerdts

Department of Heart Disease, Institute of Medicine, Haukeland University Hospital, University of Bergen, Bergen 5021, Norway

Received 23 January 2009; accepted after revision 31 May 2009.

* Corresponding author. Tel: +47 55 97 22 20; fax: +47 55 97 51 00. E-mail address: mai.tone.lonnebakken{at}helse-bergen.no


  Abstract

Aims: Quantitative contrast stress echocardiography (CSE) can assess regional myocardial perfusion. The aim of this study was to evaluate the performance of quantitative CSE in the detection of restenosis after percutaneous coronary intervention (PCI).

Methods and results: Thirty-three patients with stable coronary artery disease, scheduled for PCI, underwent CSE and quantitative coronary angiography (QCA) before and 9 months after PCI. Regional myocardial perfusion was analysed blinded to QCA results. QCA identified 38 significant stenoses (≥50% diameter reduction). Before PCI, perfusion during stress was significantly reduced in regions supplied by stenotic arteries; blood flow velocity ({Delta}β) –3.9 (–9.0 to 0.5) s–1, perfusion rate ({Delta}Axβ) –175.0 (–518.0 to 58.5) s–1, and refilling time ({Delta}rt) 210 (–22 to 452)ms, compared with the perfusion increase seen in regions supplied by non-stenotic arteries; {Delta}β 1.6 (–0.7 to 4.4) s–1, {Delta}Axβ 151.7 (–67.0 to 300.5) s–1, and {Delta}rt –47 (–195 to 89) ms, all P < 0.05. At follow-up, regional stress-induced perfusion improved in 29 regions with successful PCI; {Delta}β 0.1 (–2.7 to 3.6), {Delta}Axβ 30.5 (–133.3 to 232.1), and {Delta}rt –99 (–247 to 125), all P ≤ 0.01, although there was no improvement in nine regions with restenosis; {Delta}β 0.9 (–1.5 to 5.3), {Delta}Axβ 65.7 (–40.8 to 412.6), and {Delta}rt –79 (–268 to 163), P = NS.

Conclusion: Quantitative CSE has the potential to detect angiographically significant coronary artery stenoses as well as angiographic success after PCI.

Trial registration: ClinicalTrials.gov Identifier: NCT00354081 [ClinicalTrials.gov] .

Keywords: Quantitative contrast stress echocardiography; Myocardial perfusion; Restenosis; Quantitative coronary angiography; Percutaneous coronary intervention; Stable coronary artery disease


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