178 Quantitative evaluation of regional myocardial perfusion during dipyridamole stress by real-time myocardial contrast echocardiography in patients with and without coronary artery disease

s S17 178 Quantitative evaluation of regional myocardial perfusion during dipyridamole stress by real-time myocardial contrast echocardiography in patients with and without coronary artery disease. L. Scuteri 1, M. Revera 1, P. De Filippo 1, M. Ferlini 1 , L. Lanzarini 1, U. Canosi 1, C. Klersy 2, L. Tavazzi 1, M. Previtali 1 . 1IRCCS Policlinico S. Matteo, Cardiology, Pavia, Italy; 2Cardiology, Biometry Unit, Pavia, Italy Background: In experimental studies myocardial contrast echo (MCE) parameters of regional mycardial perfusion show a good correlation with the severity of coronary lesions, but clinical data on coronary pts are still scarce. Purpose: 1)To assess the correlation between parameters of regional myocardial perfusion derived from real-time MCE and severity of coronary lesions by quantitative coronary angiography (QCA) in pts with or without left anterior descending (LAD) disease. 2)To determine the sensitivity and specificity of MCE parameters in detecting critical LAD stenosis. Methods: 38 pts, 21 males, aged 60±7 years, 24 with ≥50% LAD stenosis, and 14 with normal or ≤50% stenosis of LAD underwent real-time MCE with Sonovue using Power Doppler Harmonic Imaging (Vivid 7 GE) at baseline and during dipyridamole(D) stress (0.84 mg/Kg in 4’). MCE time-intensity data in 2 regions of interest [proximal (SP) and distal septum (SD)] were fitted to the exponential function y= A (1-e-bt)+c, where A is the peak plateau signal intensity, b the rate of signal increase and the product A x b is proportional to myocardial blood flow. Baseline and peak stress MCE parameters were correlated with minimal luminal diameter (MLD) and % diameter stenosis (DS) of LAD by QCA. Results: See table. The product A x b in DS at peak stress was significantly related with MLD (r=.52, p=.0025) and %DS of LAD (r=.58, p=.0001)and b in DS at peak was related with %DS(r=.53, p=.0007). By ROC analysis a value of A x b 50% LAD stenosis had a 86% sensitivity and 74% specificity; for a > 70% LAD stenosis a cut-off of Axb .80 for both values. Normal/ 50%LAD disease p value basal Axb distal septum 2.14 ± 1.04 1.5 ± .86 .06 peak Axb prox septum 5.5 ± 2.03 3.2±2.19 .002 peak b distal septum .67 ± .25 .37 ± .28 .003 peak Axb distal septum 4.4 ± 2.01 2.1 ± 1.8 .0005 Conclusions: In pts with LAD disease MCE parameters of regional perfusion during D-induced hyperemia are significantly correlated with QCA parameters and show a good sensitivity and specificity for detecting critical LAD stenosis. 179 Five years of adenosine contrast echocardiography: lessons from 1750 consecutive studies in a single center. F. Morcerf 1, A. Moraes 2, M. Carrinho 1, F.C. Palheiro 1, A.C. Nogueira 1, R. Morcerf 1, C. Medeiros 1, M. Castier 1. 1ECOR Diagnostico Cardiovascular, Rio de Janeiro, Brazil; 2ECOR Diagnostico Cardiovascular, Rio de Janeiro, Brazil Background: Detection of myocardial perfusion by echocardiography with intravenous injection of contrast agents is an emergent technique. Five years ago we started our experience in humans testing different protocols (varying the stressor agents, the ultrasound technologies and PESDA administration) in 160 pts with confirmed coronary artery disease (CAD). Due to our initial results we decided by the Adenosine Contrast Echocardiography (ACE) protocol. It is performed with continuous infusion (1-2 ml/m) of PESDA associated with triggered (fixed 1:1) 2nd harmonic imaging technology, at rest and after a bolus injection of adenosine (ADN). The aim was to report the safety, tolerance and results of this protocol in the clinical scenario of CAD. Methods: 1750 consecutive pts (1085 male, 12 to 91 years), were submitted to the ACE protocol to investigate myocardial perfusion. At least 1 ampoule of 2ml/6mg of ADN was used for each echocardiographic view. Images were obtained at the standard apical 4-chamber and 2-chamber views. Myocardial perfusion was visually analyzed (2 independent investigators) in 3 perfusion beds (LAD, RCA and Cx arteries). Results: The ACE studies were interpretable for all perfusion beds in 1735 pts (99%). PESDA infusion produced myocardial contrast and ADN bolus injection enhanced it further in at least 1 LV segment wall in all pts. 980 pts (56%) required 1 amp of ADN per view to achieve further increment of the wall contrast. 525 pts (30%) and 245 pts (14%) required 2 and 3 amp respectively to obtain the same result. A transient, asymptomatic 3rd degree AV block lasting less than 10s was noted in 31, 49 and 130 pts who had 1, 2 or 3 amp of ADN respectively (total of 210 pts-12%). 262 pts (15%) complained of lightheadedness, 140 pts (8%) of headache, and, 105 pts (6%) of non-angina chest discomfort. All patients developed tachypnea. Symptoms lasted less than 30 s and did not required therapy or precluded further ADN injection if needed. All our previous papers, using coronary angiography as gold-standard in pts with high incidence of CAD, reported global accuracy superior to 90%. Conclusion: ACE protocol with PESDA infusion is safe and very well tolerated by pts with suspected CAD. 180 Contrast or transoesophageal dobutamine echo for the detection of ischaemia in poorly echogenic patients? B. Cosyns 1, J. Van der Auwera 1, M. Menassel 1, M. Mantia 1, M. Van der Hoogstraete 2, D. Schoors 2, G. Van Camp 2. 1Hop. Braine l’Alleud Waterloo, Cardiology, BraineWaterloo, Belgium; 2AZ VUB, Cardiology, Brussels, Belgium Introduction: Dobutamine echocardiography (DASE) has been shown to be a very useful non-invasive technique for the detection of myocardial ischemia. However, inadequate transthoracic images preclude the use of DASE in a significant group of patients. Transoesophageal approach (TOE) can overcome this limitation and improves endocardial border delineation. Transthoracic contrast echo (CE) has also been shown to improve left ventricular opacification at rest and during stress echo. The aim of our study: was to compare prospectively the feasibility, safety, sensitivity and specificity of dobutamine CE and TOE for the detection of coronary artery disease (CAD). Methods: 42 poorly echogenic patients scheduled for cardiac catheterisation underwent prospectively both CE and TOE dobutamine tests. All underwent coronary angiography within the 48 h. A lesion > 50% by quantitative analysis was considered significant. Results: One patient did not tolerate intubation with TOE probe but had developed wall motion abnormalities before the test was stopped. Mean duration of dobutamine TOE and CE was respectively 21.7 ± 8.0 min and 14.5 ± 1.8 min (p<0.05). There were no major complications with both techniques. Twenty-six patients of 30 patients with significant CAD using TOE and 27 using CE had a positive DASE (sensitivity: 86% vs 90%, NS). One of 12 patients without significant CAD had false positive findings using TOE, 0 using CE (specificity 92% vs 100%,NS). Conclusions: In poorly echogenic patients, dobutamine CE is a safe, feasible and accurate technique for the detection of myocardial ischemia in comparison with dobutamine TOE. Because dobutamine CE is less invasive, of shorter duration and more comfortable than TOE, it should be used in patients with suboptimal transthoracic echocardiograms for the evaluation of CAD during dobutamine stress testing. 181 Increased feasibility of myocardial contrast echo perfusion studies in poor acoustic windows with contrast pulse sequencing compared to a standard pulse cancellation method. E. Perez 1, M.A. Garcia Fernandez 2, T. Lopez Fernandez 2, M.J. Ledesma 3, A. Santos 3, N. Malpica 3, M. Moreno 2, J. Bermejo 2, A. Contreras 2, M. Desco 4. 1Majadahonda-Madrid, Spain; 2Hospital General Gregorio Maranon, Cardiology Dept., Madrid, Spain; 3Polytechnic University, Madrid, Spain; 4HGU Gregorio Maranon, Cardiology Dept., Madrid, Spain Background: Poor acoustic windows are still a drawback for the evaluation of myocardial perfusion with myocardial contrast echo (MCE). The aim of this study is to compare feasibility of MCE performed with a new imaging technology based on detection of non-linear fundamental and harmonic energy with a standard cancellation pulse method(p). Methods: 237 segments (S) from 21 non-selected consecutive p referred for transthoracic echo were evaluated. Sonovue was administered in continuous infusion. Sequences of 200 frames with temporal resolution of 75 ms were acquired in apical views with CPS, a new non-destructive MCE method and with CCI, a cancellation pulse method. Both technologies were implemented in an AcusonSiemensSequoia equipment. To analyse feasibility of both technologies and according to the quality of the perfusion image, each S was evaluated with a score ranging from 0 to 3 (0: very poor; 1: suboptimal; 2: acceptable; 3: optimal). Results: Mean global score from all S was higher with CPS than with CCI (1.96±0.07 and 1.42±0.07, p=0.0005). When 128 S corresponding to p with intermediate-poor acoustic window were selected, the advantage of CPS over CCI was largest (difference in quality score: 0.82±0.10, p=0.0005). In 58% of 55 S not visualized at all with CCI (Score=0), image quality improved with CPS. However, regional differences in CPS feasibility were observed (see figure), and quality score remained low with both techniques in basal anterior and basal lateral segments. Image quality score with CPS Conclusions: Benefit of CPS over standard pulse cancellation studies is notorious, especially in p with poor acoustic windows. However, in some cases good image acquisition is still difficult in anterobasal and laterobasal S. Eur J Echocardiography Abstracts Supplement, December 2003 by gest on July 6, 2011 ejechocafordjournals.org D ow nladed fom