Detection of Subendocardial Ischemia in the Left Anterior Descending Coronary Artery Territory With Real-Time Myocardial Contrast Echocardiography During Dobutamine Stress Echocardiography

Xie, Feng; Dodla, Saritha; O’Leary, Edward; Porter, Thomas R.

doi:10.1016/j.jcmg.2008.02.004

Cited by 27 publications

(20 citation statements)

References 19 publications

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“…RTMCE was performed using ultrasound scanners equipped with low mechanical index real-time pulse sequence schemes. [8][9][10][11][12][13] This utilized a mechanical index of <0.2, frame rates of 20 to 25 H, time gain compensation higher in the near field, focus at the mitral valve plane or below, and overall gain settings adjusted so that brief high mechanical index impulses uniformly clear the myocardial segments of any signals.…”

Section: Imaging Techniques With Ultrasound Contrastmentioning

confidence: 99%

“…Real-time myocardial contrast echocardiography (RTMCE) is a technique that utilizes ultrasound contrast for the simultaneous analysis of myocardial perfusion and wall motion (WM) during stress echocardiography. 7,8 This perfusion technique measures capillary blood flow (CBF) and volume, and thus can indirectly assess capillary microvascular resistance. 2,3 Previous studies have shown that the detection of CBF abnormalities identified with RTMCE during stress echocardiography improve the ability of echocardiography to predict patient outcome during both demand and vasodilator stress.…”

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confidence: 99%

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Comparison of Fractional Flow Reserve Assessment With Demand Stress Myocardial Contrast Echocardiography in Angiographically Intermediate Coronary Stenoses

Barton

Xie

et al. 2016

Circ: Cardiovascular Imaging

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Intracoronary pressure-derived fractional flow reserve (FFR) provides physiologically relevant information in determining the functional significance of a coronary stenosis, but provides no data regarding CBF. 6,11,12 An FFR-guided approach for revascularization is associated with improved clinical outcomes in multivessel CAD, 6 and abnormal values with this technique clearly identify a higher risk subgroup of patients. Although they do not seem to benefit from Background-Real-time myocardial contrast echocardiography (RTMCE) directly measures capillary flow (CBF), which in turn is a major regulator of coronary flow and resistance during demand or hyperemic stress. Although fractional flow reserve (FFR) was developed to assess the physiological relevance of an epicardial stenosis, it assumes maximal microvascular vasodilation and minimal resistance during vasodilator stress. Therefore, we sought to determine the relationship between CBF assessed with RTMCE during stress echocardiography and FFR in intermediate coronary lesions. Methods and Results-Sixty-seven vessels with 50% to 80% diameter stenoses by quantitative coronary angiography in 58 consecutive patients were examined with FFR and RTMCE (mean age, 60±13 years). RTMCE was performed using an incremental dobutamine (n=32) or exercise (n=26) stress protocol, and myocardial perfusion was assessed using a continuous infusion of ultrasound contrast. The presence or absence of inducible perfusion defects and wall motion abnormalities were correlated with FFR. Mean percent diameter stenosis was 60±9%. Eighteen stenoses (27%) had an FFR ≤ 0.8. Although 17 of the 18 stenoses that were FFR+ had abnormal CBF during RTMCE, 28 of the 49 stenoses (57%) that were FFR had abnormal CBF, and 24 (49%) had abnormal wall motion in the corresponding coronary artery territory during stress echocardiography. Conclusions-In

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Section: Imaging Techniques With Ultrasound Contrastmentioning

confidence: 99%

mentioning

confidence: 99%

Comparison of Fractional Flow Reserve Assessment With Demand Stress Myocardial Contrast Echocardiography in Angiographically Intermediate Coronary Stenoses

Barton

Xie

et al. 2016

Circ: Cardiovascular Imaging

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“…In a study involving 50 patients, realtime myocardial perfusion with contrast was performed during DSE. Subendocardial perfusion abnormalities that corresponded to myocardial ischemia were observed in areas where wall thickening was still preserved (21) and could further enhance the accuracy of DSE for the detection of CAD (Fig. 3).…”

Section: Figure 2 Coronary Computed Tomography Angiography With Low mentioning

confidence: 97%

The Year in Coronary Artery Disease

Achenbach

Dilsizian

Kramer

et al. 2009

JACC: Cardiovascular Imaging

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Technology in cardiovascular imaging continues to evolve rapidly. Along with new technology, new imaging approaches are continuously being developed and evaluated in various clinical settings. The workup of patients with coronary artery disease (CAD) is one of the major areas in which imaging is applied. Some of the most important aspects include diagnosing CAD through direct coronary visualization or imaging of ischemia; assessing left ventricular function, scar, and viability; and providing prognostic information both in patients with known CAD and in asymptomatic individuals at risk for disease. This article will outline some of the recent developments in the field of echocardiography, nuclear imaging, cardiac magnetic resonance (CMR), and computed tomography (CT) as they pertain to CAD.

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“…Reprinted, with permission, from Xie et al (33). (55). Because dobutamine will recruit the subepicardial layers to contract, these wall-thickening abnormalities would have gone undetected if contrast were only used to enhance endocardial borders.…”

Section: Figure 3 An Example Of a Subendocardial Perfusion Defectmentioning

confidence: 99%

“…If only transmural wall thickening were examined in this patient (Pre-MCR after High MI Impulse images), the wall thickening would have appeared normal. Reprinted, with permission, from Xie et al (55). MCR ϭ myocardial contrast replenishment.…”

Section: Figure 5 An Example Of a Subendocardial Wall-thickening Abnmentioning

confidence: 99%

Myocardial Perfusion Imaging With Contrast Ultrasound

Porter

Xie

2010

JACC: Cardiovascular Imaging

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This report reviews the development and clinical application of myocardial perfusion imaging with myocardial contrast echocardiography (MCE). This includes the development of microbubble formulations that permit the detection of left ventricular contrast from venous injection and the imaging techniques that have been invented to detect the transit of these microbubbles through the microcirculation. The methods used to quantify myocardial perfusion during a continuous infusion of microbubbles are described. A review of the clinical studies that have examined the clinical utility of myocardial perfusion imaging with MCE during rest and stress echocardiography is then presented. The limitations of MCE are also discussed.

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Detection of Subendocardial Ischemia in the Left Anterior Descending Coronary Artery Territory With Real-Time Myocardial Contrast Echocardiography During Dobutamine Stress Echocardiography

Cited by 27 publications

References 19 publications

Comparison of Fractional Flow Reserve Assessment With Demand Stress Myocardial Contrast Echocardiography in Angiographically Intermediate Coronary Stenoses

Comparison of Fractional Flow Reserve Assessment With Demand Stress Myocardial Contrast Echocardiography in Angiographically Intermediate Coronary Stenoses

The Year in Coronary Artery Disease

Myocardial Perfusion Imaging With Contrast Ultrasound

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