Determinants of myocardial hypoperfusion analyzed for the interventricular septum using power Doppler harmonic imaging with contrast echocardiography in humans: A methodologic approach for clinical practice

Background: To evaluate determinants of myocardial hypoperfusion using power Doppler harmonic imaging (PDHI) with myocardial contrast echocardiography (MCE) in clinical practice, a retrospective clinical study was performed comparing echocardiographic and angiographic data. Angiographic data of patients with a normal coronary angiogram (non-CAD) and symptomatic patients with low flow conditions caused by a stenosis of the left anterior descending coronary artery (LAD) or occlusion, or TIMI-II-flow in the LAD were compared with the PDHI data. Methods and Results: In 32 patients, MCE was performed with a System Five Performance ultrasound system (GE Vingmed Ultrasound, Horten, Norway). Myocardial perfusion was semiquantitatively analyzed with the EchoPac 6.2b.134 software, bolus injection with Optison (0.35 mL with 5 mL saline flush), and continuous infusion with Levovist (400 mg/mL−1; 3.5-5 mL/min−1) were performed (8 non-CAD patients, 8 CAD patients, respectively). After bolus injection, Doppler intensity (DI) kinetics showed a significant decrease of maximum DI wash-in rate (eg, apical septum [AS]: 4.9 ± 3.3 vs 2.4 ± 1.9 dB/s−1), of peak maximum DI (eg, AS: 25.3 ± 6.3 vs 16.4 ± 5.7 dB), and of DI determined 10 and 20 seconds after peak maximum DI (eg, AS: 22.1 ± 4.9 vs 10.8 ± 4.6 dB; AS: 20.4 ± 5.3 vs 8.0 ± 3.8 dB, respectively) using a trigger interval once every 3 cardiac cycles when normal perfused areas were compared with hypoperfused areas. During infusion coronary transit time (3.3 ± 0.9 vs 7.0 ± 3.6 seconds), maximum DI wash-in rate (eg, AS: 3.2 ± 1.3 vs 1.3 ± 0.8 dB/s−1) and DI-maximum plateau (eg, AS: 28.6 ± 4.7 vs 18.3 ± 6.4 dB) significantly decreased, respectively. Conclusion: Regional myocardial hypoperfusion at rest can be detected by using PDHI with MCE in clinical practice, according to a standardized methodologic protocol. (J Am Soc Echocardiogr 2002;15:404-16.)