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European Heart Journal 1992 13(3):389-394;
Copyright © 1992 by the European Society of Cardiology.
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© 1992 The European Society of Cardiology

Evaluation of coronary flow reserve using myocardial contrast echocardiography in humans

S. A. REISNER*,, L. S. ONG, P. G. FITZPATRICK, G. S. LICHTENBERG, J. T. SULLEBARGER, M. N. ALLEN and R. S. MELTZER

Departments of Medicine and Anesthesiology and the Center for Biomedical Ultrasound, University of Rochester Rochester, NY, U.S.A.
*Department of Cardiology, Rambam Medical Center Haifa, Israel

Received 20 July 1990; revised 20 May 1991; .

Correspondence. Shimon A. Reisner, MD, Department of Cardiology, Rambam Medical Center, Haifa, Israel 31096

Abstract

To evaluate the applicability of myocardial contrast echocardiography for the assessment of coronary blood flow reserve, 21 consecutive patients undergoing coronary angiography were studied. Only patients with a single left anterior descending lesion or normal coronary angiogram were included. Intracoronary injections of sonicated albumin were performed before and after the administration of intracoronary papa verine. Good quality studies at baseline and after the administration of papaverine were obtained in 14 of 21 patients. Ten patients had a signficant (>75%) single left anterior descending lesion amd four had normal or insignificant lesions (70% or less stenosis) in the left anterior descending coronary artery. Time-intensity curves for the left anterior descending coronary artery region of interest were generated and then the peak contrast intensity (PCI), washout half-time (T1/2) and the area under the curve (AUC) were calculated. The post-papaverine increases in PCI a.nd in the AUC, compared to baseline, were 55 ± 22% and 102 ± 14% in the four patients with 70% or less left anterior descending diameter stenosis serving as a control group and 3 ± 25% and 40 ± 10%, respectively, in the 10 patients with significant left anterior descending coronary artery disease (mean ± 1 SD, P <0.01). In patients with normal coronary arteriographv T1/2 increased after intracoronary injection ofpapaverine. In patients with severe lesions, either an increase or a decrease in T1/2 was observed. Significant left anterior descending coronary artery stenosis associated with impaired coronary blood flow reserve can be detected by failure of myocardial contrast echocardiographic parameters to increase after injection of papaverine. Mild and transient side effects were noted in three patients.

Key Words: Echocardiography • contrast echocardiography • coronary low reserve


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