Coronary anatomy and myocardial perfusion: Role of contrast echocardiography

Coronary stenoses reduce coronary flow and, consequently, myocardial perfusion. This is the main cause of clinical symptoms of coronary artery disease. Though coronary arteriography is the most important diagnostic examination for evaluating this disease, it does have several limitations. It cannot, for example, estimate the actual ‘haemodynamic’ severity of the coronary stenoses and, therefore, its real significance in limiting myocardial perfusion. Interpretation of coronary angiograms is also affected by an intra- and inter-observer variability which cannot be overlooked [1, 2]. Furthermore, coronary arteriography as performed in most institutions gives only qualitative information on the distribution and characteristics of coronary stenoses. Myocardial perfusion is further influenced by many other factors which cannot be evaluated by coronary angiography (the microcirculation, heart muscle conditions, interstitial characteristics, wall stress, collateral circulation etc.).