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(Circulation. 2001;104:1550.)
© 2001 American Heart Association, Inc.

Basic Science Reports

Comparison of Real-Time and Intermittent Triggered Myocardial Contrast Echocardiography for Quantification of Coronary Stenosis Severity and Transmural Perfusion Gradient

Hisashi Masugata, MD; Stephane Lafitte, MD; Barry Peters, MD; G. Monet Strachan, RDCS; Anthony N. DeMaria, MD

From the Cardiovascular Division, University of California at San Diego.

Correspondence to Anthony N. DeMaria, MD, Cardiovascular Division, UCSD Medical Center, 200 W Arbor St, San Diego, CA 92103-8411. E-mail ademaria{at}ucsd.edu

Background— Both intermittent triggered and real-time myocardial contrast echocardiography (MCE) have been proposed to detect impaired myocardial perfusion. We compared the ability of these 2 methods to quantify altered myocardial blood flow (MBF) and transmural distribution of MBF produced by graded coronary stenoses.

Methods and Results— In 8 open-chest dogs, we created 4 graded left anterior descending coronary artery (LAD) stenoses: 3 levels of reduced adenosine hyperemia (non–flow-limiting at rest) and 1 grade of flow-limiting at rest. Real-time MCE was performed with SonoVue infusion using low-energy power pulse inversion (ATL) imaging, whereas ECG-gated intermittent triggered imaging used high energy at pulsing intervals from 1:1 to 1:10. LAD signal intensity (SI) was plotted versus time by real-time MCE and versus pulsing intervals by triggered MCE and was fitted to a 1-exponential function to obtain plateau SI (A) and the rate of SI rise (b). Visual detection of decreased opacification was equivalent by triggered and real-time MCE. Fluorescent microsphere–derived MBF ratio in LAD/left circumflex artery beds demonstrated close correlation with both real-time imaging (b, r=0.79; Axb, r=0.81) and triggered imaging (b, r=0.78; Axb, r=0.80). The endocardial/epicardial ratio of MBF in the LAD bed demonstrated closer correlation with the endocardial/epicardial ratios of b (r=0.71) and Axb (r=0.67) obtained by real-time than triggered imaging (b, r=0.42; Axb, r=0.52).

Conclusions— Real-time and triggered MCE are equivalent in their ability to identify coronary stenosis and quantify altered MBF.

Key Words: echocardiography • perfusion • blood flow

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