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European Journal of Echocardiography 2007 8(3):s24-s29; doi:10.1016/j.euje.2007.03.005
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Copyright © 2007, The European Society of Cardiology

The clinical applications of myocardial contrast echocardiography

Dhrubo J. Rakhita, Harald Becherb, Mark Monaghanb, Petros Nihoyannopoulisc and Roxy Seniora,*

aDepartment of Cardiology, Northwick Park Hospital, Watford Road, Harrow HA1 3UJ, UK
bOxford University, John Radcliffe Hospital, Oxford, OX3 9DZ, UK
cNational Heart and Lung Institute, Hammersmith Hospital, London W12 0HS, UK

* Corresponding author. Tel.: +44 208 869 2547/2548; fax: +44 208 864 0075. roxysenior{at}cardiac-research.org


   Abstract
Top
 Abstract
Introduction
 Myocardial perfusion
 Clinical applications of MCE
 Future directions
 Conclusions
 References
 
Recent updates in the field of echocardiography have resulted in improvements in both image quality and techniques allowing echocardiography to maintain it's position as the primary non-invasive imaging modality. In particular, the development of new ultrasound contrast agents and imaging techniques have now made possible the assessment of myocardial perfusion. Myocardial contrast echocardiography utilises acoustically active gas filled microspheres (microbubbles), which have rheology similar to that of red blood cells. The detection of myocardial perfusion during echocardiographic examinations permits simultaneous assessment of global and regional myocardial structure, function, and perfusion, enabling the optimal non-invasive assessment of coronary artery disease. Myocardial contrast echocardiography is equally adept in assessing chronic coronary artery disease, acute coronary syndromes and hibernating myocardium.

Keywords: Echocardiography; Ultrasound contrast


   Introduction
Top
 Abstract
 Introduction
Myocardial perfusion
 Clinical applications of MCE
 Future directions
 Conclusions
 References
 
Ultrasound contrast agents have been in clinical use for nearly 40 years but in the last decade refinements in both the types of agent as well as echocardiographic technologies has resulted in a new range of clinical applications. In the early days of contrast agents, imaging left sided structures with contrast enhancement was not possible because the bubbles were too large to cross the pulmonary vasculature. Modern day contrast agents have the ability to opacify the left heart and can be useful in, for example, endocardial border definition for patients with difficult echo windows. Myocardial contrast echocardiography (MCE) is an emerging technique for detection of perfusion abnormalities in patients with coronary artery disease. The article examines the precise nature of contrast agents in current clinical use as well as defining the specific clinical applications of MCE.


   Myocardial perfusion
Top
 Abstract
 Introduction
 Myocardial perfusion
Clinical applications of MCE
 Future directions
 Conclusions
 References
 
The techniques for quantitative assessment of myocardial perfusion are dependant on an understanding of the components of myocardial blood volume and myocardial blood flow. Whilst the coronary blood volume comprises the coronary arteries, arterioles, capillaries, venules, veins and coronary sinus, the myocardial blood volume is made up of vessels which are <300 microns in diameter, most of which (>90%) lies within the capillaries.1 Once injection of a myocardial contrast agent has occurred, within a few seconds, the agent will be present within the myocardial capillaries and once a steady state is achieved the signal intensity represents the myocardial blood volume (A).The rate of increase in intensity following bubble destruction with a high energy pulse represents red blood cell velocity (β) and the product of the Axβ represents myocardial blood flow (MBF).2 To quantify MBF the use of specialist software is required to determine regions of interest, at rest and stress, in the 4 apical segments: midanterior septum, and midanterior segment representing the anterior coronary circulation and in the midinferior, midposterior, and midlateral segments representing the posterior circulation. The software can automatically construct background-subtracted plots of peak myocardial contrast intensity, A, versus pulsing intervals, from which the slope of the replenishment curve depicting mean microbubble velocity, β reserve and MBF2 can be derived. Coronary flow reserve (i.e., stress MBF/rest MBF) and β and A reserve can then be calculated.


   Clinical applications of MCE
Top
 Abstract
 Introduction
 Myocardial perfusion
 Clinical applications of MCE
Future directions
 Conclusions
 References
 
Coronary artery disease
Coronary artery disease is very common in the western world but with the advent of thrombolytic therapy and more recently primary angioplasty mortality rates from myocardial infarction have been declining.3 However in the emergency department, a prompt diagnosis is essential in the management of patients presenting with acute chest pain. The serum troponin level may be elevated in certain patients for reasons other than myocardial necrosis4 and so in some patients, particularly those with negative cardiac enzymes or in those where there is diagnostic uncertainty as to whether the ECG changes warrant thrombolytic therapy, other tests are required. In this situation, 2D resting echocardiography can be very useful for detection of wall motion abnormalities5 but may not be reliable in all patients such as those with left ventricular hypertrophy.6 Myocardial contrast echocardiography is a rapid bedside technique which can detect perfusion abnormalities in patients with acute coronary syndromes (ACS).7 In addition, MCE has prognostic importance in patients with suspected CAD.8

Stable disease
One of the early studies in man compared the use of MCE with sestamibi SPECT in 30 patients with known or suspected coronary artery disease undergoing dipyridamole stress.9 The overall concordance for the detection of CAD was 86% and identification of the perfusion abnormality location was similar between the two techniques. There are a number of studies which have compared perfusion abnormalities by MCE to coronary angiography as a gold standard. In one series of 85 patients, of whom 70 underwent coronary angiography, the sensitivity of MCE for CAD detection was 91%.10 More recently in 123 patients who underwent coronary angiography it was found that MCE and SPECT had similar sensitivity (84% vs. 82%) and specificity (56% vs. 52%) for the diagnosis of CAD.11 Such studies suggest that MCE is a reliable and accurate technique for the identification of CAD in patients with suspected ischaemia heart disease. Table 1 shows all studies comparing the ability of MCE with coronary angiography, as a gold standard, to diagnose CAD.


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  		Table 1 Studies comparing the ability of MCE with coronary angiography

 
Acute coronary syndromes
The portability of MCE to the bedside makes it a very powerful tool in assessment of patients with acute myocardial infarction (AMI) and it is possible to rapidly stratify patients to high and low risk in the acute emergency setting. In a study of 114 patients admitted to an emergency department with chest pain but no ST segment elevation on the ECG, the accuracy of standard diagnostic testing (electrocardiograph, cardiac enzymes and regional wall motion abnormalities on resting 2D echocardiography) were compared to MCE using qualitative triggered imaging.7 All patients underwent either coronary angiography or SPECT. The sensitivity of MCE for the diagnosis of ACS was higher (77%) than the other methods (ST change 28%, troponin I 34%, wall motion abnormalities 49%). The specificities were similar (86–93%). In another similar study, 100 patients presenting with chest pain to the emergency department underwent quantitative MCE, 37 of whom had ACS diagnosed by standard criteria.28 The sensitivity of quantitative MCE for the diagnosis of ACS was 94% and the specificity 84%. In two studies the usefulness of MCE in the triage of patients presenting with chest pain and no ST elevation on the ECG have been demonstrated.29,30 In one study the incremental prognostic benefit of MCE over conventional parameters and regional function by echo were shown in over 1000 patients.29 In another study the advantages of MCE over regional function and conventional Thrombolysis in Myocardial Infarction (TIMI) risk scoring assessment was demonstrated.30 Hence MCE is a clinically useful imaging tool in the management of patients with undiagnosed chest pain in the emergency department. In patients with myocardial infarction undergoing coronary angiography, MCE appears to be better than SPECT at predicting the extent of CAD.31 The best technique for the assessment of myocardial viability following infarction is an area of ongoing debate and the contribution of MCE is discussed in the following section.

Myocardial viability
Following AMI or even during a prolonged ischaemic insult, left ventricular dysfunction is common. It is thought that the impairment in ventricular function is reversible particularly if the myocardium is hibernating or stunned.32 Stunned myocardium refers to the transient left ventricular dysfunction which often occurs following a period of acute ischaemia (such as successful reperfusion following AMI). Hibernating myocardium is usually found in the setting of chronic CAD when ventricular dysfunction improves following revascularisation. Unfortunately in many patients with chronic CAD and impairment of ventricular function, despite adequate restoration of blood flow, ventricular function does not improve as the myocardium is completely infarcted. Therefore a reliable method is required to distinguish between infarcted and viable myocardium allowing the identification of patients with chronic ischaemia ventricular impairment with hibernating myocardium that would benefit from revascularisation. Myocardial contrast echocardiography can identify viable myocardium33,34 which is useful in two clinical situations – (i) predicting recovery post-AMI and (ii) chronic ischaemic left ventricular dysfunction.

Post-myocardial infarction
In patients with AMI it has been shown that MCE can provide incremental value in the assessment of myocardial viability to dobutamine stress echocardiography35 and in addition MCE, with or without the combination of dobutamine echo, can predict the recovery of left ventricular function.36,37 In a study of 30 patients who underwent primary percutaneous intervention (PCI), MCE was performed before reperfusion and at 3–5 days and 4 weeks after reperfusion.37 It was found that in 68 segments with no perfusion prior to PCI, 51 (75%) had restoration of perfusion at 3–5 days. For segments without perfusion at 3–5 days, 95% had severe hypokinesis to akinesis at 4 weeks. For segments with normal perfusion at 3–5 days, 90% had normal wall motion or mild hypokinesis at 4 weeks, whereas those with partial perfusion at 3–5 days were divided between normal wall motion, hypokinesis, and akinesis. It has also been shown that MCE can predict transmurality of infarction.38,39 In the first study to show this cardiac magnetic resonance (CMR) and MCE was performed in 42 patients who were 7–10 days post-thrombolytic therapy for AMI.39 Both qualitative (contrast intensity) and quantitative (β, MBF and peak contrast intensity) MCE demonstrated an inverse correlation to transmurality extent of infarction, defined by CMR. In another study of patients with AMI, MCE was performed 3–5 days after administration of thrombolytic therapy and compared to CMR performed at 2 weeks.40 Left ventricular volumes were lower and ejection fraction was higher by CMR in those patients who had viable myocardium by MCE compared to those who demonstrated non-viability. In comparison to SPECT, MCE is more accurate in defining the transmurality extent of infarction.41 In another study with 35 patients with AMI, MCE was performed immediately before, 1h and 24h after primary PCI.42 Left ventricular end diastolic volume was measured at 4 weeks to provide an estimation of left ventricular remodeling (>15% increase in size). It was found that patients with remodeling had larger perfusion defects by MCE before 1h and 24h after PCI compared to those who had no remodeling. Similar findings have been confirmed by others.43 In the assessment of viability following AMI, MCE at 1 week has been shown to be a predictor of contractile reserve at 3 months44 and is considered to be as accurate as CMR for this.45 The sensitivity and specificity of MCE for the prediction of functional recovery was 87 and 90%, respectively.

Chronic ischaemic left ventricular dysfunction
Chronic ischaemic left ventricular dysfunction is usually a result of multi-vessel CAD and for this reason many of the studies examining viability in this clinical setting involve patients due for coronary bypass surgery (CBG). One of the earliest studies of 35 patients, with a mean ejection fraction of 36%, awaiting revascularisation by PCI or CBG compared MCE and dobutamine echo.46 Revascularisation was successful in 23 patients and follow up echo was performed 1–2 months later and over 80% of hypokinetic segments showed functional improvement. Both MCE and dobutamine echo were effective at predicting viable segments but there was no difference between the two techniques. However this study was over 10 years ago and more recent data do suggest that MCE is a better technique. In one study of 20 patients who had MCE and 2D echo 1–5 days prior to CBG and 3–4 months later.47 Patients also had dobutamine echo and SPECT prior to surgery. It was found that sensitivity (90%) and specificity (63%) of quantitative MCE was higher than SPECT or dobutamine echo at prediction of functional recovery. Other groups have also shown similar findings48,49 supporting the role of MCE for identification of viable myocardium in chronic ischaemia.

Heart failure
Another potential clinical use for MCE is in patients with acute heart failure although there is little data for this. Certainly it is important to distinguish ischaemic aetiology of heart failure from non-ischaemic causes. There is one study to support the role of MCE for this50 and it was found that the sensitivity and specificity of MCE for the detection of CAD in this clinical setting was 82 and 97%, respectively.


   Future directions
Top
 Abstract
 Introduction
 Myocardial perfusion
 Clinical applications of MCE
 Future directions
Conclusions
 References
 
The future of MCE is very promising particularly with the advent of 3D echocardiographic probes and with further refinements and developments in software it may be soon possible for the assessment of myocardial perfusion using this technique. Another exciting area is the possibility of the local delivery of drug therapy to the myocardium using contrast agents as the medium51 – so far this has only been used experimentally.


   Conclusions
Top
 Abstract
 Introduction
 Myocardial perfusion
 Clinical applications of MCE
 Future directions
 Conclusions
References
 
In the last decade MCE has grown from a promising technique to a powerful clinical tool for the evaluation of patients with acute cardiac disease. It can provide detailed information regarding functional status and severity of ischaemic heart disease very rapidly. MCE is safe. There are some training issues which mainly relate to the limited exposure of trainees to expert supervision. If these can be addressed, MCE should become more widely practiced in the next few years.


   References
Top
 Abstract
 Introduction
 Myocardial perfusion
 Clinical applications of MCE
 Future directions
 Conclusions
 References
 

  1. Kaul S., Jayaweera A.R. Coronary and myocardial blood volumes: noninvasive tools to assess the coronary microcirculation? Circulation (1997) 96:719–724.[Web of Science][Medline]
  2. Wei K., Jayaweera A.R., Firoozan S., Linka A., Skyba D.M., Kaul S. Quantification of myocardial blood flow with ultrasound-induced destruction of microbubbles administered as a constant venous infusion. Circulation (1998) 97:473–483.[Abstract/Free Full Text]
  3. Kalla K., Christ G., Karnik R., Malzer R., Norman G., Prachar H., et al. Implementation of guidelines improves the standard of care: the Viennese registry on reperfusion strategies in ST-elevation myocardial infarction (Vienna STEMI registry). Circulation (2006) 113:2398–2405.[Abstract/Free Full Text]
  4. Korff S., Katus H.A., Giannitsis E. Differential diagnosis of elevated troponins. Heart (2006) 92:987–993.[Free Full Text]
  5. Weston P., Alexander J.H., Patel M.R., Maynard C., Crawford L., Wagner G.S. Hand-held echocardiographic examination of patients with symptoms of acute coronary syndromes in the emergency department: the 30-day outcome associated with normal left ventricular wall motion. Am Heart J (2004) 148:1096–1101.[CrossRef][Web of Science][Medline]
  6. Neuman Y., Cercek B., Aragon J., Lee S., Kobal S., Miyamoto T., et al. Comparison of frequency of left ventricular wall motion abnormalities in patients with a first acute myocardial infarction with versus without left ventricular hypertrophy. Am J Cardiol (2004) 94:763–766.[CrossRef][Web of Science][Medline]
  7. Kang D.H., Kang S.J., Song J.M., Choi K.J., Hong M.K., Song J.K., et al. Efficacy of myocardial contrast echocardiography in the diagnosis and risk stratification of acute coronary syndrome. Am J Cardiol (2005) 96:1498–1502.[CrossRef][Web of Science][Medline]
  8. Basic D., Siu S.C., Skyba D.M., Sloggett C., Jamorski M., Iwanochko R.M., et al. Prognostic value of myocardial perfusion contrast echocardiography in patients with suggested or known ischemic heart disease. J Am Soc Echocardiogr (2006) 19:1203–1210.[CrossRef][Web of Science][Medline]
  9. Kaul S., Senior R., Dittrich H., Raval U., Khattar R., Lahiri A. Detection of coronary artery disease with myocardial contrast echocardiography: comparison with 99mTc-sestamibi single-photon emission computed tomography. Circulation (1997) 96:785–792.[Abstract/Free Full Text]
  10. Moir S., Haluska B.A., Jenkins C., Fathi R., Marwick T.H. Incremental benefit of myocardial contrast to combined dipyridamole-exercise stress echocardiography for the assessment of coronary artery disease. Circulation (2004) 110:1108–1113.[Abstract/Free Full Text]
  11. Jeetley P., Hickman M., Kamp O., Lang R.M., Thomas J.D., Vannan M.A., et al. Myocardial contrast echocardiography for the detection of coronary artery stenosis: a prospective multicenter study in comparison with single-photon emission computed tomography. J Am Coll Cardiol (2006) 47:141–145.[Abstract/Free Full Text]
  12. Chiou K.R., Huang W.C., Lin S.L., Hsieh P.L., Liu C.P., Tsay D.G., et al. Real-time dobutamine stress myocardial contrast echocardiography for detecting coronary artery disease: correlating abnormal wall motion and disturbed perfusion. Can J Cardiol (2004) 20:1237–1243.[Web of Science][Medline]
  13. Cwajg J., Xie F., O'Leary E., Kricsfeld D., Dittrich H., Porter T.R. Detection of angiographically significant coronary artery disease with accelerated intermittent imaging after intravenous administration of ultrasound contrast material. Am Heart J (2000) 139:675–683.[Web of Science][Medline]
  14. Elhendy A., O'Leary E.L., Xie F., McGrain A.C., Anderson J.R., Porter T.R. Comparative accuracy of real-time myocardial contrast perfusion imaging and wall motion analysis during dobutamine stress echocardiography for the diagnosis of coronary artery disease. J Am Coll Cardiol (2004) 44:2185–2191.[Abstract/Free Full Text]
  15. Heinle S.K., Noblin J., Goree-Best P., Mello A., Ravad G., Mull S., et al. Assessment of myocardial perfusion by harmonic power Doppler imaging at rest and during adenosine stress: comparison with (99m)Tc-sestamibi SPECT imaging. Circulation (2000) 102:55–60.[Abstract/Free Full Text]
  16. Karavidas A.I., Matsakas E.P., Lazaros G.A., Brestas P.S., Avramidis D.A., Zacharoulis A.A., et al. Comparison of myocardial contrast echocardiography with SPECT in the evaluation of coronary artery disease in asymptomatic patients with LBBB. Int J Cardiol (2006) 112:334–340.[CrossRef][Web of Science][Medline]
  17. Korosoglou G., Dubart A.E., DaSilva K.G. Jr., Labadze N., Hardt S., Hansen A., et al. Real-time myocardial perfusion imaging for pharmacologic stress testing: added value to single photon emission computed tomography. Am Heart J (2006) 151:131–138.[CrossRef][Web of Science][Medline]
  18. Lin S.L., Chiou K.R., Huang W.C., Peng N.J., Tsay D.G., Liu C.P. Detection of coronary artery disease using real-time myocardial contrast echocardiography: a comparison with dual-isotope resting thallium-201/stress technectium-99m sestamibi single-photon emission computed tomography. Heart Vessels (2006) 21:226–235.[CrossRef][Web of Science][Medline]
  19. Malm S., Frigstad S., Torp H., Wiseth R., Skjarpe T. Quantitative adenosine real-time myocardial contrast echocardiography for detection of angiographically significant coronary artery disease. J Am Soc Echocardiogr (2006) 19:365–372.[CrossRef][Web of Science][Medline]
  20. Moir S., Haluska B.A., Jenkins C., McNab D., Marwick T.H. Myocardial blood volume and perfusion reserve responses to combined dipyridamole and exercise stress: a quantitative approach to contrast stress echocardiography. J Am Soc Echocardiogr (2005) 18:1187–1193.[CrossRef][Web of Science][Medline]
  21. Olszowska M., Kostkiewicz M., Tracz W., Przewlocki T. Assessment of myocardial perfusion in patients with coronary artery disease. Comparison of myocardial contrast echocardiography and 99mTc MIBI single photon emission computed tomography. Int J Cardiol (2003) 90:49–55.[CrossRef][Web of Science][Medline]
  22. Peltier M., Vancraeynest D., Pasquet A., Ay T., Roelants V., D'Hondt A.M., et al. Assessment of the physiologic significance of coronary disease with dipyridamole real-time myocardial contrast echocardiography. Comparison with technetium-99m sestamibi single-photon emission computed tomography and quantitative coronary angiography. J Am Coll Cardiol (2004) 43:257–264.[Abstract/Free Full Text]
  23. Rocchi G., Fallani F., Bracchetti G., Rapezzi C., Ferlito M., Levorato M., et al. Non-invasive detection of coronary artery stenosis: a comparison among power-Doppler contrast echo, 99Tc-Sestamibi SPECT and echo wall-motion analysis. Coron Artery Dis (2003) 14:239–245.[CrossRef][Web of Science][Medline]
  24. Senior R., Lepper W., Pasquet A., Chung G., Hoffman R., Vanoverschelde J.L., et al. Myocardial perfusion assessment in patients with medium probability of coronary artery disease and no prior myocardial infarction: comparison of myocardial contrast echocardiography with 99mTc single-photon emission computed tomography. Am Heart J (2004) 147:1100–1105.[CrossRef][Web of Science][Medline]
  25. Shimoni S., Zoghbi W.A., Xie F., Kricsfeld D., Iskander S., Gobar L., et al. Real-time assessment of myocardial perfusion and wall motion during bicycle and treadmill exercise echocardiography: comparison with single photon emission computed tomography. J Am Coll Cardiol (2001) 37:741–747.[Abstract/Free Full Text]
  26. Tsutsui J.M., Xie F., McGrain A.C., Mahrous H., Hankins J., O'Leary E.L., et al. Comparison of low-mechanical index pulse sequence schemes for detecting myocardial perfusion abnormalities during vasodilator stress echocardiography. Am J Cardiol (2005) 95:565–570.[CrossRef][Web of Science][Medline]
  27. Winter R., Gudmundsson P., Willenheimer R. Real-time perfusion adenosine stress echocardiography in the coronary care unit: a feasible bedside tool for predicting coronary artery stenosis in patients with acute coronary syndrome. Eur J Echocardiogr (2005) 6:31–40.[Abstract/Free Full Text]
  28. Korosoglou G., Labadze N., Hansen A., Selter C., Giannitsis E., Katus H., et al. Usefulness of real-time myocardial perfusion imaging in the evaluation of patients with first time chest pain. Am J Cardiol (2004) 94:1225–1231.[CrossRef][Web of Science][Medline]
  29. Rinkevich D., Kaul S., Wang X.Q., Tong K.L., Belcik T., Kalvaitis S., et al. Regional left ventricular perfusion and function in patients presenting to the emergency department with chest pain and no ST-segment elevation. Eur Heart J (2005) 26:1606–1611.[Abstract/Free Full Text]
  30. Tong K.L., Kaul S., Wang X.Q., Rinkevich D., Kalvaitis S., Belcik T., et al. Myocardial contrast echocardiography versus thrombolysis in myocardial infarction score in patients presenting to the emergency department with chest pain and a nondiagnostic electrocardiogram. J Am Coll Cardiol (2005) 46:920–927.[Abstract/Free Full Text]
  31. Dwivedi G., Janardhanan R., Hayat S., Senior R. Detection of residual infarct-related coronary artery stenosis and multivessel disease after thrombolysis: comparison between myocardial contrast echocardiography and single photon emission computed tomography. J Am Soc Echocardiogr (2006) 19:546–551.[CrossRef][Web of Science][Medline]
  32. Rahimtoola S.H. The hibernating myocardium. Am Heart J (1989) 117:211–221.[CrossRef][Web of Science][Medline]
  33. Nagueh S.F., Vaduganathan P., Ali N., Blaustein A., Verani M.S., Winters W.L. Jr., et al. Identification of hibernating myocardium: comparative accuracy of myocardial contrast echocardiography, rest-redistribution thallium-201 tomography and dobutamine echocardiography. J Am Coll Cardiol (1997) 29:985–993.[Abstract]
  34. Shimoni S., Frangogiannis N.G., Aggeli C.J., Shan K., Quinones M.A., Espada R., et al. Microvascular structural correlates of myocardial contrast echocardiography in patients with coronary artery disease and left ventricular dysfunction: implications for the assessment of myocardial hibernation. Circulation (2002) 106:950–956.[Abstract/Free Full Text]
  35. Senior R., Swinburn J.M. Incremental value of myocardial contrast echocardiography for the prediction of recovery of function in dobutamine nonresponsive myocardium early after acute myocardial infarction. Am J Cardiol (2003) 91:397–402.[CrossRef][Web of Science][Medline]
  36. Hillis G.S., Mulvagh S.L., Pellikka P.A., Hagen M.E., Gunda M., Wright R.S., et al. Comparison of intravenous myocardial contrast echocardiography and low-dose dobutamine echocardiography for predicting left ventricular functional recovery following acute myocardial infarction. Am J Cardiol (2003) 92:504–508.[CrossRef][Web of Science][Medline]
  37. Balcells E., Powers E.R., Lepper W., Belcik T., Wei K., Ragosta M., et al. Detection of myocardial viability by contrast echocardiography in acute infarction predicts recovery of resting function and contractile reserve. J Am Coll Cardiol (2003) 41:827–833.[Abstract/Free Full Text]
  38. Choi E.Y., Seo H.S., Park S., Kim H.J., Ahn J.A., Ko Y.G., et al. Prediction of transmural extent of infarction with contrast echocardiographically derived index of myocardial blood flow and myocardial blood volume fraction: comparison with contrast-enhanced magnetic resonance imaging. J Am Soc Echocardiogr (2006) 19:1211–1219.[CrossRef][Web of Science][Medline]
  39. Janardhanan R., Moon J.C., Pennell D.J., Senior R. Myocardial contrast echocardiography accurately reflects transmurality of myocardial necrosis and predicts contractile reserve after acute myocardial infarction. Am Heart J (2005) 149:355–362.[CrossRef][Web of Science][Medline]
  40. Jeetley P., Swinburn J., Hickman M., Bellenger N.G., Pennell D.J., Senior R. Myocardial contrast echocardiography predicts left ventricular remodelling after acute myocardial infarction. J Am Soc Echocardiogr (2004) 17:1030–1036.[CrossRef][Web of Science][Medline]
  41. Hayat S.A., Janardhanan R., Moon J.C., Pennell D.J., Senior R. Comparison between myocardial contrast echocardiography and single-photon emission computed tomography for predicting transmurality of acute myocardial infarction. Am J Cardiol (2006) 97:1718–1721.[CrossRef][Web of Science][Medline]
  42. Lepper W., Kamp O., Vanoverschelde J.L., Franke A., Sieswerda G.T., Pasquet A., et al. Intravenous myocardial contrast echocardiography predicts left ventricular remodeling in patients with acute myocardial infarction. J Am Soc Echocardiogr (2002) 15:849–856.[CrossRef][Web of Science][Medline]
  43. Main M.L., Hannen M.N., Kusnetzky L.L., Martin J.L., Coggins T.R., Lanza P., et al. Myocardial contrast echocardiographic estimates of infarct size predict likelihood of left ventricular remodeling after acute anterior wall myocardial infarction. J Am Soc Echocardiogr (2006) 19:64–70.[CrossRef][Web of Science][Medline]
  44. Hickman M, Janardhanan R, Dwivedi G, Burden L, Senior, R. Clinical significance of perfusion techniques utilising different physiological mechanisms to detect myocardial viability: a comparative study with myocardial contrast echocardiography and single photon emission computed tomography. Int J Cardiol 2007;114(1):139–40.
  45. Biagini E., van Geuns R.J., Baks T., Boersma E., Rizzello V., Galema T.W., et al. Comparison between contrast echocardiography and magnetic resonance imaging to predict improvement of myocardial function after primary coronary intervention. Am J Cardiol (2006) 97:361–366.[CrossRef][Web of Science][Medline]
  46. deFilippi C.R., Willett D.L., Irani W.N., Eichhorn E.J., Velasco C.E., Grayburn P.A. Comparison of myocardial contrast echocardiography and low-dose dobutamine stress echocardiography in predicting recovery of left ventricular function after coronary revascularization in chronic ischemic heart disease. Circulation (1995) 92:2863–2868.[Abstract/Free Full Text]
  47. Shimoni S., Frangogiannis N.G., Aggeli C.J., Shan K., Verani M.S., Quinones M.A., et al. Identification of hibernating myocardium with quantitative intravenous myocardial contrast echocardiography: comparison with dobutamine echocardiography and thallium-201 scintigraphy. Circulation (2003) 107:538–544.[Abstract/Free Full Text]
  48. Fukuda S., Hozumi T., Muro T., Watanabe H., Hyodo E., Yoshiyama M., et al. Quantitative intravenous myocardial contrast echocardiography predicts recovery of left ventricular function after revascularization in chronic coronary artery disease. Echocardiography (2004) 21:119–124.[CrossRef][Web of Science][Medline]
  49. Aggeli C., Stefanadis C., Bonou M., Pitsavos C., Theocharis C., Roussakis G., et al. Prediction of functional recovery of hibernating myocardium using harmonic power Doppler imaging and dobutamine stress echocardiography in patients with coronary artery disease. Am J Cardiol (2003) 91:1415–1420.[CrossRef][Web of Science][Medline]
  50. Senior R., Janardhanan R., Jeetley P., Burden L. Myocardial contrast echocardiography for distinguishing ischemic from nonischemic first-onset acute heart failure: insights into the mechanism of acute heart failure. Circulation (2005) 112:1587–1593.[Abstract/Free Full Text]
  51. Tsutsui J.M., Xie F., Porter R.T. The use of microbubbles to target drug delivery. Cardiovasc Ultrasound (2004) 2:23.[CrossRef][Medline]

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Corrigendum to "The clinical applications of myocardial contrast echocardiography" [Eur J Echocardiogr 2007;8:S24–S29]
Dhrubo J. Rakhit, Harald Becher, Mark Monaghan, Petros Nihoyannopoulos, and Roxy Senior
Eur J Echocardiogr 2007 8: 307. [Extract] [Full Text]  



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