This Article Full Text Full Text (PDF) All Versions of this Article: 112/11/1587    most recent CIRCULATIONAHA.104.530089v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Senior, R. Articles by Burden, L. Search for Related Content PubMed PubMed Citation Articles by Senior, R. Articles by Burden, L. Related Collections Other heart failure Echocardiography

(Circulation. 2005;112:1587-1593.)
© 2005 American Heart Association, Inc.

Imaging

Myocardial Contrast Echocardiography for Distinguishing Ischemic From Nonischemic First-Onset Acute Heart Failure

Insights Into the Mechanism of Acute Heart Failure

From the Cardiovascular Division, Northwick Park Hospital, Harrow, England, UK.

Correspondence to Dr Roxy Senior, MD, DM FRCP, FESC, FACC, Consultant Cardiologist and Director of Cardiac Research, Department of Cardiovascular Medicine, Institute of Medical Research, Northwick Park Hospital, Watford Road, Harrow, Middlesex, HA1 3UJ. E-mail roxy.senior{at}virgin.net

Received December 17 2004; revision received May 25, 2005; accepted June 6, 2005.

Background— Distinguishing ischemic from nonischemic origin in patients presenting with acute heart failure (AHF) not resulting from acute myocardial infarction has both therapeutic and prognostic implications. The aim of the study was to assess whether myocardial contrast echocardiography (MCE) can identify underlying coronary artery disease (CAD) as the cause of AHF.

Methods and Results— Fifty-two consecutive patients with AHF with no prior clinical history of CAD and no clinical evidence of acute myocardial infarction underwent resting echocardiography and MCE both at rest and after dipyridamole stress at a mean of 9±2 days after admission. All patients underwent coronary arteriography before discharge. Of the 52 patients, 22 demonstrated flow-limiting CAD (>50% luminal diameter narrowing). Sensitivity, specificity, and positive and negative predictive values of MCE for the detection of CAD were 82%, 97%, 95%, and 88%, respectively. Among clinical, ECG, biochemical, resting echocardiographic, and MCE markers of CAD, MCE was the only independent predictor of CAD (P<0.0001). Quantitative MCE demonstrated significantly (P<0.0001) lower myocardial blood flow velocity reserve in vascular territories subtended by >50% CAD (0.59±0.46) compared with patients with normal coronary arteries (1.99±1.00). However, myocardial blood flow velocity reserve in patients with no significant CAD was significantly (P=0.03) lower compared with control (2.91±0.41). Myocardial blood flow velocity reserve correlated significantly (P<0.0001) with increasing severity of CAD.

Conclusions— MCE, which is a bedside technique, may be used to detect CAD in patients presenting with AHF without a prior history of CAD or evidence of acute myocardial infarction. Quantitative MCE may further risk-stratify patients with AHF but no CAD.

Key Words: coronary disease • diagnosis • echocardiography • heart failure

This article has been cited by other articles:

				S. Kaul Myocardial Contrast Echocardiography: A 25-Year Retrospective Circulation, July 15, 2008; 118(3): 291 - 308. [Full Text] [PDF]

				S.A. Hayat, G. Dwivedi, A. Jacobsen, T.K. Lim, C. Kinsey, and R. Senior Effects of Left Bundle-Branch Block on Cardiac Structure, Function, Perfusion, and Perfusion Reserve: Implications for Myocardial Contrast Echocardiography Versus Radionuclide Perfusion Imaging for the Detection of Coronary Artery Disease Circulation, April 8, 2008; 117(14): 1832 - 1841. [Abstract] [Full Text] [PDF]

				G. Dwivedi, R. Janardhanan, S. A. Hayat, J. M. Swinburn, and R. Senior Prognostic Value of Myocardial Viability Detected by Myocardial Contrast Echocardiography Early After Acute Myocardial Infarction J. Am. Coll. Cardiol., July 24, 2007; 50(4): 327 - 334. [Abstract] [Full Text] [PDF]

				D. J. Rakhit, H. Becher, M. Monaghan, P. Nihoyannopoulis, and R. Senior The clinical applications of myocardial contrast echocardiography Eur J Echocardiogr, June 1, 2007; 8(3): s24 - s29. [Abstract] [Full Text] [PDF]

				P. A. Dijkmans, R. Senior, H. Becher, T. R. Porter, K. Wei, C. A. Visser, and O. Kamp Myocardial Contrast Echocardiography Evolving as a Clinically Feasible Technique for Accurate, Rapid, and Safe Assessment of Myocardial Perfusion: The Evidence So Far J. Am. Coll. Cardiol., November 8, 2006; (2006) j.jacc.2006.05.079v1. [Abstract] [Full Text] [PDF]

				A. E. Weyman The Year in Echocardiography J. Am. Coll. Cardiol., February 21, 2006; 47(4): 856 - 863. [Full Text] [PDF]