Published Online
on August 15, 2005

A more recent version of this article appeared on August 23, 2005

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Submitted on October 12, 2004
Revised on May 3, 2005
Accepted on May 4, 2005

Detection of Coronary Stenoses at Rest With Myocardial Contrast Echocardiography

Kevin Wei MD^*, Khim Leng Tong MD, Todd Belcik RDCS, Patrick Rafter BS, Michael Ragosta MD, Xin-Qun Wang MS, and Sanjiv Kaul MD

From the Cardiovascular Imaging Center, Cardiovascular Division, Department of Medicine (K.W., K.L.T., T.B., M.R., S.K.), and the Division of Biostatistics and Epidemiology, Department of Health Evaluation Sciences (X.-Q.W.), University of Virginia, Charlottesville, and Philips Ultrasound (P.R.), Andover, Mass. Dr. Tong is currently at Changi General Hospital, Singapore.

^* To whom correspondence should be addressed. E-mail: weik{at}OHSU.edu.

Background--We hypothesized that autoregulatory changes in arteriolar blood volume (aBV) that develop distal to a stenosis can be measured with myocardial contrast echocardiography, allowing coronary stenosis detection at rest without recourse to stress.

Methods and Results--Patients with varying degrees of coronary artery stenosis on quantitative angiography underwent high-mechanical-index myocardial contrast echocardiography at 15 Hz to allow measurement of phasic changes in aBV in large intramyocardial vessels using either Definity (group 1; n=22) or Imagent (group 2; n=22). Progressive increases in the background-subtracted systolic/diastolic aBV signal ratio were noted between each level (none, mild [<50%], moderate [50% to 75%], and severe [>75%]) of stenosis severity for both group 1 (0.09±0.13, 0.13±0.08, 0.58±0.22, and 0.77±0.40; P<0.001) and group 2 (0.10±0.05, 0.27±0.18, 0.39±0.28, and 0.74±0.37; P<0.0001) patients. A systolic/diastolic aBV signal ratio of >0.34 provided a sensitivity and specificity of 80% and 71%, respectively, for the detection of >75% coronary stenosis in group 1 patients, whereas a ratio of >0.43 provided a sensitivity and specificity of 89% and 74%, respectively, for the detection of >75% stenosis in group 2 patients.

Conclusions--Both the presence and severity of a physiologically significant coronary stenosis can be detected at rest by measuring the increase in aBV on myocardial contrast echocardiography that occurs distally to the stenosis without recourse to any form of stress.

Key words: contrast media • coronary disease • diagnosis • echocardiography • imaging

Related Article:

Stress Echo Without the Stress: Detection of Coronary Stenosis at Rest by Myocardial Contrast Echocardiography

Paul A. Grayburn
Circulation 2005 112: 1085-1087. [Extract] [Full Text]

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