J Cardiovasc Ultrasound.  2014 Sep;22(3):121-126. 10.4250/jcu.2014.22.3.121.

Myocardial Contrast Echocardiography for the Detection of Coronary Artery Disease in Patients with Global Hypokinesis Admitted for First-Onset Acute Heart Failure: Pilot Study

• Kim SE
• Park DG
• Hong JY
• Lee JH
• Han KR
• Oh DJ

• KMID: 2045427
• DOI: http://doi.org/10.4250/jcu.2014.22.3.121

Abstract

BACKGROUND
The non-invasive differentiation of ischemic and nonischemic acute heart failure (AHF) not resulting from acute myocardial infarction is difficult and has therapeutic and prognostic implications. The aim of this study was to assess whether resting myocardial contrast echocardiography (MCE) can detect coronary artery disease (CAD) in patients with decreased left ventricular (LV) systolic function and global hypokinesis presenting with AHF.
METHODS
Twenty-one consecutive patients underwent low-power real-time MCE based on color-coded pulse inversion Doppler. Standard apical LV views were acquired during contrast IV infusion of Definity(R). Following transient microbubbles destruction, the contrast replenishment rate (beta), reflecting myocardial blood flow velocity, was derived by plotting signal intensity vs. time and fitting data to the exponential function: y (t) = A (1 - e(-beta(t-t0))) + C.
RESULTS
Of the 21 (mean age 56.6 +/- 13.6 years) patients, 5 (23.8%) demonstrated flow-limiting CAD (> 70% of luminal diameter narrowing). The mean +/- standard deviation of LV ejection fraction was 29.6 +/- 8.6%. Quantitative MCE analysis was feasible in 258 of 378 segments (68.3%). There were no significant difference in "beta" and "Abeta" in patients without and with CAD (0.48 +/- 0.27 vs. 0.45 +/- 0.25, p = 0.453 for beta and 2.99 +/- 2.23 vs. 3.68 +/- 3.13, p = 0.059 for Abeta, respectively). No contrast-related side effects were reported.
CONCLUSION
Resting quantitative MCE analysis in patients with AHF was feasible, however, the parameters did not aid in detecting of CAD.

Keyword

Coronary disease; Diagnosis; Echocardiography; Heart failure

MeSH Terms

Blood Flow Velocity
Coronary Artery Disease*
Coronary Disease
Diagnosis
Echocardiography*
Heart Failure*
Humans
Microbubbles
Myocardial Infarction
Phenobarbital
Pilot Projects*
Phenobarbital

Figure

• 

  Fig. 1 Case of 81-year-old female. Apical 4-chamber, 2-chamber, and 3-chamber view showed partial perfusion defect in inferior and inferolateral wall (arrows, A). Coronary arteriography showed 70% stenosis in mid left anterior descending artery, and total occlusion of right coronary artery and left circumflex artery (B).

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