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Quantitative Stress Echocardiography in Coronary Artery Disease Using Contrast-Based Myocardial Blood Flow Measurements: Prospective Comparison with Coronary Angiography
  1. Rolf Vogel (rolf.vogel{at}insel.ch)
  1. Cardiology, Bern University Hospital, Switzerland
    1. Andreas Indermühle (andreas.indermuehle{at}insel.ch)
    1. Cardiology, Bern University Hospital, Switzerland
      1. Pascal Meier (pascal.meier{at}insel.ch)
      1. Cardiology, Bern University Hospital, Switzerland
        1. Christian Seiler (christian.seiler{at}insel.ch)
        1. Cardiology, Bern University Hospital, Switzerland

          Abstract

          Aim: The purpose of study was to test whether quantitative stress echocardiography using contrast-based myocardial blood flow (MBF, ml/min/g) measurements can detect coronary artery disease in humans.

          Methods: 48 patients eligible for pharmacologic stress testing by myocardial contrast echocardiography (MCE) and willing to undergo subsequent coronary angiography were prospectively enrolled in the study. Baseline and adenosine-induced (140microgr/kg/min) hyperemic MBF was analyzed according to a 3-coronary-artery-territory model. Vascular territories were categorized into three groups with increasing stenosis severity defined as percent diameter reduction by quantitative coronary angiography.

          Results: Myocardial blood flow reserve (MBFR), i.e. the ratio of hyperemic to baseline MBF, was obtained in 128 (89%) territories. Mean±SD baseline MBF was 1.073±0.395ml/min/g and did not differ between territories supplied by coronary arteries with mild (<50% stenosis), moderate (50%-74% stenosis) or severe (>75% stenosis) disease. Mean±SD hyperemic MBF and MBFR were 2.509±1.078ml/min/g and 2.54±1.03, respectively, and decreased linearly (r2=0.21 and r2=0.39) with stenosis severity. ROC analysis revealed that a territorial MBFR<1.94 detected >50% stenosis with 89% sensitivity and 92% specificity.

          Conclusion: Quantitative stress testing based on myocardial blood flow measurements derived from contrast echocardiography is a new method for the non-invasive and reliable assessment of coronary artery disease in humans.

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