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Two dimensional echocardiography is an excellent method to evaluate anatomic cardiac structures and assess myocardial function. Although the evaluation of myocardial perfusion has been studied extensively experimentally [1,2] in the last decade, myocardial contrast two-dimensional echocardiography only recently has shown its clinical potential [3,4,5,6,7]. These studies were performed in the cardiac catheterization laboratory using intracoronary injections or recently, after intravenous injections [3,8]. This goal has been mainly achieved by Dr. Steven Feinstein of the University of Chicago who created a new method -sonication -to prepare echocontrast agents containing microbubbles capable of capillary transit.

Myocardial contrast two-dimensional (2D) echocardiography is a relatively new technique which was developed and validated in animals to determine myocardial perfusion. However, human studies are scarce. Therefore, myocardial contrast 2D echocardiography was performed in 32 patients with suspected coronary artery disease immediately after coronary arteriography. Two milliliters of sonicated iopamidol (microbubbles size 12 ± 4 pm) was injected intracoronarily during continuous recording of échocardiographie apical four-chamber view. Visible myocardial contrast was achieved in 82% of patients (25 patients) and 62% of injections (96 injections). Perfusion defects were detected in 5 of 6 patients with > 90% stenosis without collateral circulation and in none of the 7 patients with collateral flow. Normally contracting segments were opacified in every instance, while this occurred only in 7 of 15 areas with contraction abnormalities. No wall motion abnormalities resulted from intracoronary sonicated iopamidol. Minor transient electrocardiographic changes (ST-T segment changes) were noted, which were similar as seen after routine coronary arteriography. Patients showed no complaints after injection of the echocontrast. Myocardial contrast 2D echocardiography is a potential useful method for the real-time analysis of myocardial perfusion in humans.