CLINICAL RESEARCH: ECHOCARDIOGRAPHY
The quantification of absolute myocardial perfusion in humans by contrast echocardiography
Algorithm and validation
Rolf Vogel, MD, PhD, MSEE*,
Andreas Indermühle, MD*,
Jessica Reinhardt, MD*,
Pascal Meier, MD*,
Patrick T. Siegrist, MD ,
Mehdi Namdar, MD,
Philipp A. Kaufmann, MD and
Christian Seiler, MD, FACC, FESC*,*
* Department of Cardiology, University Hospital, Bern, Switzerland
Department of Nuclear Cardiology, University Hospital, Zurich, Switzerland
Manuscript received July 14, 2004;
revised manuscript received October 29, 2004,
accepted November 16, 2004.
* Reprint requests and correspondence: Dr. Christian Seiler, Professor and Co-Chairman of Cardiology, University Hospital Bern, CH-3010 Bern, Switzerland (Email: christian.seiler.cardio{at}insel.ch).
OBJECTIVES: We sought to test whether myocardial blood flow (MBF) can be quantified by myocardial contrast echocardiography (MCE) using a volumetric model of ultrasound contrast agent (UCA) kinetics for the description of refill curves after ultrasound-induced microsphere destruction.
BACKGROUND: Absolute myocardial perfusion or MBF (ml·min–1·g–1) is the gold standard to assess myocardial blood supply, and so far it could not be obtained by ultrasound.
METHODS: The volumetric model yielded MBF = rBV·ß/ T, where T equals tissue density. The relative myocardial blood volume rBV and its exchange frequency ß were derived from UCA refill sequences. Healthy volunteers underwent MCE and positron emission tomography (PET) at rest (group I: n = 15; group II: n = 5) and during adenosine-induced hyperemia (group II). Fifteen patients with coronary artery disease underwent simultaneous MCE and intracoronary Doppler measurements before and during intracoronary adenosine injection.
RESULTS: In vitro experiments confirmed the volumetric model and the reliable determination of rBV and ß for physiologic flow velocities. In group I, 187 of 240 segments were analyzable by MCE, and a linear relation was found between MCE and PET perfusion data (y = 0.899x + 0.079; r2 = 0.88). In group II, resting and hyperemic perfusion data showed good agreement between MCE and PET (y = 1.011x + 0.124; r2 = 0.92). In patients, coronary stenosis varied between 0% to 89%, and myocardial perfusion reserve was in good agreement with coronary flow velocity reserve (y = 0.92x + 0.14; r2 = 0.73).
CONCLUSIONS: The volumetric model of UCA kinetics allows the quantification of MBF in humans using MCE and provides the basis for the noninvasive and quantitative assessment of coronary artery disease.
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Abbreviations and Acronyms
| | CAD = coronary artery disease | | CCI = coherent contrast imaging | | CFVR = coronary flow velocity reserve | | MBD = manual bubble destruction | | MBF = myocardial blood flow | | MCE = myocardial contrast echocardiography | | MPR = myocardial perfusion reserve | | PET = positron emission tomography | | rBV = relative blood volume | | UCA = ultrasound contrast agent |
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