Noninvasive quantification of coronary blood flow reserve in humans using myocardial contrast echocardiography
1Cardiac Imaging Center and the Cardiovascular Division, University of Virginia School of Medicine, Charlottesville, VA, USA. kw6n@virginia.edu
Insights
Myocardial contrast echocardiography (MCE) noninvasively quantifies coronary blood flow (CBF) reserve in humans. This technique accurately assesses coronary stenosis severity and detects microvascular dysfunction.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Physiology
Background:
- Coronary blood flow (CBF) reserve assessment is crucial for diagnosing cardiovascular conditions.
- Noninvasive methods for quantifying CBF reserve are highly desirable in clinical practice.
Purpose of the Study:
- To investigate the feasibility of using myocardial contrast echocardiography (MCE) for noninvasive quantification of CBF reserve in humans.
- To compare MCE-derived measurements with invasive methods and assess their correlation with coronary stenosis severity.
Main Methods:
- Quantitative coronary angiography, MCE, and coronary blood flow (CBF) velocity measurements were performed in 11 patients with normal coronary arteries and 19 with coronary stenosis.
- Measurements were taken at rest and during intravenous adenosine infusion to assess hyperemia-induced flow changes.
Main Results:
- MCE-derived myocardial blood flow (MBF) velocity reserve closely correlated with CBF velocity reserve measured by Doppler flow wire in healthy individuals.
- MBF velocity reserve was significantly reduced in patients with increasing severity of coronary stenosis.
- A strong linear relationship was observed between MCE-derived and Doppler-derived flow velocity reserves, and a curvilinear relationship between stenosis severity and velocity reserve.
Conclusions:
- Myocardial contrast echocardiography (MCE) provides a reliable noninvasive method for measuring coronary blood flow (CBF) reserve in humans.
- MCE has the potential to noninvasively assess the severity of coronary artery stenosis and identify microvascular dysfunction.
Background:
We hypothesized that coronary blood flow (CBF) reserve could be quantified noninvasively in humans using myocardial contrast echocardiography (MCE).
Methods And Results:
Eleven patients with normal epicardial coronary arteries (group I) and 19 with single-vessel coronary stenosis (group II) underwent quantitative coronary angiography, MCE, and CBF velocity measurements at rest and during intravenous adenosine infusion. In group I patients, MCE-derived myocardial blood flow (MBF) velocity reserve (2.4+/-0.08) was similar to CBF velocity reserve using a Doppler flow wire (2.4+/-1.1). Patients with a single risk factor had a significantly higher MBF reserve (3.0+/-0.89) than those with >/=2 risk factors (1.7+/-0.22). In group II patients, significant differences were found in MBF velocity reserve in patients with mild (<50%), moderate (50% to 75%), or severe (>75%) stenoses (2.2+/-0.40, 1.6+/-0.65, and 0.55+/-0.19, respectively; P=0.005). A linear relation was found between flow velocity reserve determined using the 2 methods (r=0.76, P<0.001), and a curvilinear relation was noted between the percent coronary stenosis measured using quantitative coronary angiography and velocity reserve using both methods.
Conclusions:
CBF reserve can be measured in humans using MCE. This method may allow the noninvasive assessment of coronary stenosis severity and the detection of microvascular dysfunction.
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