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Quantitative stress echocardiography in coronary artery disease using contrast-based myocardial blood flow
R Vogel1, A Indermühle, P Meier
1Bern University Hospital and University of Bern, Switzerland, Bern, Switzerland. rolf.vogel@insel.ch
Insights
Quantitative stress echocardiography using myocardial blood flow (MBF) measurements can reliably detect coronary artery disease. This contrast-enhanced ultrasound method offers a new, non-invasive approach for assessing cardiac health.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Techniques
Background:
- Coronary artery disease (CAD) diagnosis often relies on invasive procedures.
- Non-invasive methods for assessing myocardial blood flow (MBF) are crucial for early detection.
- Echocardiography offers a potential platform for quantitative MBF assessment.
Purpose of the Study:
- To evaluate the efficacy of quantitative stress echocardiography with contrast-enhanced myocardial blood flow (MBF) measurements in detecting coronary artery disease in humans.
- To establish the correlation between MBF reserve and the severity of coronary artery stenosis.
Main Methods:
- Prospective enrollment of 48 patients undergoing pharmacological stress testing with myocardial contrast echocardiography (MCE) and coronary angiography.
- Analysis of baseline and adenosine-induced hyperemic MBF in three coronary artery territories.
- Categorization of vascular territories based on stenosis severity determined by quantitative coronary angiography.
Main Results:
- Myocardial blood flow reserve (MBFR) was successfully obtained in 89% of territories.
- Hyperemic MBF and MBFR decreased linearly with increasing coronary stenosis severity.
- A territorial MBFR cutoff of <1.94 demonstrated 89% sensitivity and 92% specificity for detecting >=50% stenosis.
Conclusions:
- Quantitative stress testing using contrast echocardiography-derived MBF measurements provides a novel, non-invasive, and reliable method for assessing coronary artery disease.
- This technique holds promise for improving the diagnostic accuracy of CAD detection.
Aim:
To test whether quantitative stress echocardiography using contrast-based myocardial blood flow (MBF, ml x min(-1) x g(-1)) measurements can detect coronary artery disease in humans.
Methods:
48 patients eligible for pharmacological stress testing by myocardial contrast echocardiography (MCE) and willing to undergo subsequent coronary angiography were prospectively enrolled in the study. Baseline and adenosine-induced (140 microg x kg(-1) x min(-1)) hyperaemic MBF was analysed according to a three-coronary-artery-territory model. Vascular territories were categorised into three groups with increasing stenosis severity defined as percentage diameter reduction by quantitative coronary angiography.
Results:
Myocardial blood flow reserve (MBFR)-that is, the ratio of hyperaemic to baseline MBF, was obtained in 128 (89%) territories. Mean (SD) baseline MBF was 1.073 (0.395) ml x min(-1) x g(-1) and did not differ between territories supplied by coronary arteries with mild (<50% stenosis), moderate (50%-74% stenosis) or severe (>or=75% stenosis) disease. Mean (SD) hyperaemic MBF and MBFR were 2.509 (1.078) ml x min(-1) x g(-1) and 2.54 (1.03), respectively, and decreased linearly (r2 = 0.21 and r2 = 0.39) with stenosis severity. ROC analysis revealed that a territorial MBFR <1.94 detected >or=50% stenosis with 89% sensitivity and 92% specificity.
Conclusion:
Quantitative stress testing based on MBF measurements derived from contrast echocardiography is a new method for the non-invasive and reliable assessment of coronary artery disease in humans.
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