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J Am Coll Cardiol, 2005; 45:754-762, doi:10.1016/j.jacc.2004.11.044
© 2005 by the American College of Cardiology Foundation
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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{dagger}, Mehdi Namdar, MD{dagger}, Philipp A. Kaufmann, MD{dagger} and Christian Seiler, MD, FACC, FESC*,*

* Department of Cardiology, University Hospital, Bern, Switzerland
{dagger} 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/{rho}T, where {rho}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.

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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