Real-time perfusion imaging with low mechanical index pulse inversion Doppler imaging

Porter, Thomas R.; Xie, Feng; Silver, Mary; Kricsfeld, David; O’Leary, Edward

doi:10.1016/s0735-1097(00)01204-3

Cited by 156 publications

(109 citation statements)

References 11 publications

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“…[5][6][7] Low-MI imaging is less technically demanding than triggered imaging and enables simultaneous assessment of myocardial perfusion and wall motion in real time. 8 For both high-and low-MI MCE imaging, vasodilators are the most feasible stressors, [5][6][7] but these agents do not reliably provoke inducible WMAs. 9 Conversely, exercise is the preferred stress in active patients but has proven technically challenging for MCE because of immediate postexercise hyperventilation, cardiac translational motion, and the relatively short duration of hyperemia.…”

mentioning

confidence: 99%

Incremental Benefit of Myocardial Contrast to Combined Dipyridamole-Exercise Stress Echocardiography for the Assessment of Coronary Artery Disease

et al. 2004

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Background-Although assessment of myocardial perfusion by myocardial contrast echocardiography (MCE) is feasible, its incremental benefit to stress echocardiography is not well defined. We examined whether the addition of MCE to combined dipyridamole-exercise echocardiography (DExE) provides incremental benefit for evaluation of coronary artery disease (CAD). Methods and Results-MCE was combined with DExE in 85 patients, 70 of whom were undergoing quantitative coronary angiography and 15 patients with a low probability of CAD. MCE was acquired by low-mechanical-index imaging in 3 apical views after acquisition of standard resting and poststress images. Wall motion, left ventricular opacification, and MCE components of the study were interpreted sequentially, blinded to other data. Significant (Ͼ50%) stenoses were present in 43 patients and involved 69 coronary territories. The addition of qualitative MCE improved sensitivity for the detection of CAD (91% versus 74%, Pϭ0.02) and accurate recognition of disease extent (87% versus 65% of territories, Pϭ0.003), with a nonsignificant reduction in specificity. Conclusions-The addition of low-mechanical-index MCE to standard imaging during DExE improves detection of CAD and enables a more accurate determination of disease extent.

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confidence: 99%

Incremental Benefit of Myocardial Contrast to Combined Dipyridamole-Exercise Stress Echocardiography for the Assessment of Coronary Artery Disease

et al. 2004

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“…In recent years, myocardial contrast echocardiography has been demonstrated to be a feasible and accurate method for the evaluation of myocardial perfusion in many clinical settings (2)(3)(4)(5). In addition, the combination of intravenous contrast agents and RTMCE with application of high-mechanical index impulses for microbubble destruction followed by myocardial replenishment has permitted the quantification of myocardial blood flow (19,20).…”

Section: Discussionmentioning

confidence: 99%

“…Microbubbles were prepared by hand shaking 8 mL of decafluorobutane gas with a 3:1 mixture of 5% dextrose and 5% human serum albumin and the mixture was sonicated for 75 s. The mean concentration of microbubbles produced with this technique was 1.4 x 10 9 microbubbles per mL and the mean size was 4.6 ± 0.2 µm (as reported in Ref. 2). RTMCE was obtained by continuous intravenous infusion of 0.2 mL/kg PESDA diluted in 80 mL of normal saline at a rate of 2-3 mL/min, injected through the femoral vein.…”

Section: Myocardial Contrast Echocardiographymentioning

confidence: 99%

“…The development of low-mechanical index imaging techniques that cause minimal microbubble destruction has permitted simultaneous analysis of myocardial perfusion and function in real time (2). Real-time myocardial contrast echocardiography (RTMCE) increases the sensitivity of dobutamine stress testing for the detection of coronary artery disease (3,4) and can distinguish between stunned and infarcted myocardium after acute ischemia (5).…”

Section: Introductionmentioning

confidence: 99%

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Bioeffects of albumin-encapsulated microbubbles and real-time myocardial contrast echocardiography in an experimental canine model

Dourado

Tsutsui

Santos

et al. 2006

Braz J Med Biol Res

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Myocardial contrast echocardiography has been used for assessing myocardial perfusion. Some concerns regarding its safety still remain, mainly regarding the induction of microvascular alterations. We sought to determine the bioeffects of microbubbles and real-time myocardial contrast echocardiography (RTMCE) in a closed-chest canine model. Eighteen mongrel dogs were randomly assigned to two groups. Nine were submitted to continuous intravenous infusion of perfluorocarbon-exposed sonicated dextrose albumin (PESDA) plus continuous imaging using power pulse inversion RTMCE for 180 min, associated with manually deflagrated high-mechanical index impulses. The control group consisted of 3 dogs submitted to continuous imaging using RTMCE without PESDA, 3 dogs received PESDA alone, and 3 dogs were sham-operated. Hemodynamics and cardiac rhythm were monitored continuously. Histological analysis was performed on cardiac and pulmonary tissues. No hemodynamic changes or cardiac arrhythmias were observed in any group. Normal left ventricular ejection fraction and myocardial perfusion were maintained throughout the protocol. Frequency of mild and focal microhemorrhage areas in myocardial and pulmonary tissue was similar in PESDA plus RTMCE and control groups. The percentages of positive microscopical fields in the myocardium were 0.4 and 0.7% (P = NS) in the PESDA plus RTMCE and control groups, respectively, and in the lungs they were 2.1 and 1.1%, respectively (P = NS). In this canine model, myocardial perfusion imaging obtained with PESDA and RTMCE was safe, with no alteration in cardiac rhythm or left ventricular function. Mild and focal myocardial and pulmonary microhemorrhages were observed in both groups, and may be attributed to surgical tissue manipulation.

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“…Porter and his colleagues demonstrated that simultaneous assessment of myocardial perfusion and LV wall motion with real time MCE imaging was superior to regional wall motion analysis only during dobutamine stress echocardiography [21]. In 117 patients, among whom 40 patients had QCA, a better agreement between MCE and QCA (83%) was observed than that between wall motion abnormality and QCA (72%).…”

Section: Mce In the Detection Of Coronar Y Arter Y Stenosismentioning

confidence: 99%

Assessment of Myocardial Perfusion With Intravenous Myocardial Contrast Echocardiography Current State and Clinical Applications

Chung

2006

J Echocardiogr

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Real-time perfusion imaging with low mechanical index pulse inversion Doppler imaging

Abstract: Pulse inversion Doppler imaging allows the detection of myocardial perfusion abnormalities in real-time during stress echocardiography and will further add to the quality and sensitivity of this test.

Cited by 156 publications

References 11 publications

Incremental Benefit of Myocardial Contrast to Combined Dipyridamole-Exercise Stress Echocardiography for the Assessment of Coronary Artery Disease

Incremental Benefit of Myocardial Contrast to Combined Dipyridamole-Exercise Stress Echocardiography for the Assessment of Coronary Artery Disease

Bioeffects of albumin-encapsulated microbubbles and real-time myocardial contrast echocardiography in an experimental canine model

Assessment of Myocardial Perfusion With Intravenous Myocardial Contrast Echocardiography Current State and Clinical Applications

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