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Real-time assessment of myocardial perfusion and wall motion during bicycle and treadmill exercise echocardiography: comparison with single photon emission computed tomography

Sarah Shimoni, MD^*, William A. Zoghbi, MD, FACC^*, Feng Xie, MD, David Kricsfeld, BS, Sherif Iskander, MD^*, Lisa Gobar, MD, Issam A. Mikati, MD^*, John Abukhalil, RT^*, Mario S. Verani, MD, FACC^*, Edward L. O’Leary, MD, FACC and Thomas R. Porter, MD, FACC

^* Section of Cardiology, Baylor College of Medicine, Houston, Texas, USA
Department of Internal Medicine, Section of Cardiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
Department of Radiology, University of Nebraska Medical Center, Omaha, Nebraska, USA

View larger version (62K): [in a new window]   Figure 1 An example of normal myocardial contrast enhancement and the corresponding single photon emission computed tomography during bicycle exercise. At low mechanical index and frame rate, uniform contrast enhancement is seen at rest and is more prominent during exercise. Less contrast is seen when imaging at high frame rate (systolic frame shown), because of more bubble destruction.

View larger version (62K): [in a new window]   Figure 2 An example of an inducible anteroseptal and apical wall motion abnormality and contrast defect (arrows) with accelerated intermittent imaging during supine bicycle stress. The corresponding SPECT defect, which extends into the midseptum, is shown. Display is similar to Figure 1. SPECT = single photon emission computed tomography.

View larger version (95K): [in a new window]   Figure 3 Lateral wall myocardial contrast enhancement using accelerated intermittent imaging during treadmill exercise stress in two different patients. The top panels show normal basal lateral segment attenuation, while the bottom panels show the dynamic images in a patient with a lateral wall contrast defect. Note that the perfusion defect in the patient with a true defect (bottom panels) extended out to the distal segment of the lateral wall, which would be uncharacteristic of attenuation. ED = end-diastole; ES = end-systole.