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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

View larger version (59K): [in a new window]   Figure 1 Region-of-interest placement (solid white lines) for in vitro and human studies. (A) Contrast image of the perfusion phantom, left and right echo-dense structure represents the cross-section of the hemodialysis filter and the left-ventricular analogue, respectively. The trapezoidal appearance of the filter is caused by total reflectance on the filter housing. (B) Four-chamber view of a healthy volunteer.

View larger version (21K): [in a new window]   Figure 2 Summary of perfusion studies of filter one (left panels) and two (right panels). Myocardial contrast echocardiography (MCE) perfusion parameter ß (A), relative blood volume (rBV) (B), and filter flow QMCE (C) are plotted versus calibrated pump flow Qpump. Solid lines = regression lines.

View larger version (29K): [in a new window]   Figure 3 Segmental refill curves (solid circles) and corresponding left ventricular signal intensities (solid triangles) reconstructed from a myocardial contrast echocardiography (MCE) perfusion sequence at rest. Upper and lower dashed lines = ALV and A; dotted lines = ± 1 SD of ALV; solid lines = the fitting to y(t) = a·(1 – e–ß·t) + c with the myocardial plateau intensity A = a + c. Segmental data of ß, relative blood volume (rBV), and myocardial blood flow (MBF) are given in s–1, ml·ml–1, and ml·min–1·g–1, respectively. For the calculation of MBFMCE, ß data were transformed into min–1. PET = positron emission tomography.

View larger version (17K): [in a new window]   Figure 4 Segmental myocardial blood flow (MBF) data at rest from group I. (A) Comparison of myocardial contrast echocardiography (MCE) and positron emission tomography (PET) by linear regression analysis (solid line). (B) Bland-Altman plot of MCE and PET perfusion data; dashed and dotted lines specify mean ± 1 SD of the measurement difference.

View larger version (25K): [in a new window]   Figure 5 Territorial myocardial contrast echocardiography (MCE) and positron emission tomography (PET) perfusion at rest (open circles) and during hyperemia (solid circles) of group II volunteers. Dashed, dotted, and solid lines indicate regression lines between resting, hyperemic, and pooled perfusion data, respectively. MBF = myocardial blood flow.

View larger version (16K): [in a new window]   Figure 6 Adenosine-induced coronary vasodilator reserve of the patient group assessed by myocardial contrast echocardiography and intracoronary Doppler velocity measurements. CFVR = coronary flow velocity reserve; MPR = myocardial perfusion reserve.