The potential of contrast enhanced digital subtraction echocardiography to demonstrate and quantitate myocardial perfusion was evaluated in 36 patients undergoing routine coronary arteriography or angioplasty. In 24 technically successful studies, multiple cross sectional echocardiographic images, obtained before and after intracoronary (sonicated contrast) injection, were stored by high speed, real time data transfer to an on line minicomputer. Subsequent digital subtraction processing of the stored image data provided composite images in which the distribution of myocardial perfusion was easily seen. Quantitative analysis of peak enhanced myocardial grey level and washout half time successfully differentiated between myocardial segments in which angiography had suggested normal, reduced, and grossly impaired or absent perfusion. The results suggest that this new method of digital image capture and quantitative processing has substantial advantages over previous off line qualitative techniques. It is likely to be of considerable value for routine coronary arteriography, angioplasty, and coronary thrombolysis.
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