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Figure 1 Myocardial contrast echocardiogram (apical four-chamber view) in a 61-year-old woman with an anterior wall MI. Two-dimensional imaging revealed akinesis of the mid- and distal septum. (A) Baseline power Doppler image. A small amount of contrast from a previous injection is visible in the LV cavity. (B) Bolus injection of contrast, opacifying the right ventricular cavity. (C) Several cardiac cycles later, the LV cavity is fully opacified. (D) Dense myocardial opacification throughout the septum, apex and lateral walls, indicating perfusion within the zone of akinesis ("perfusion-contraction mismatch"). At follow-up echocardiography, wall motion was normal. (E) Flash imaging with high mechanical index. (F) Immediately after flash imaging, the myocardium is no longer opacified, secondary to microbubble destruction. Note continued LV cavity opacification due to much higher contrast agent concentration.
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