Contrast echocardiography in the evaluation of myocardial flow reserve
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In order to determine whether changes in myocardial perfusion can be assessed by myocardial contrast echocardiography, intracoronary injections of 2 ml of sonicated iopromid were performed before and 30 to 45 s after application of papaverine in 31 patients (mean age 58 years). 13 patients showed coronary artery disease (KHE), 6 patients hypertensive heart disease (HHE), and 12 patients had no proven heart disease (KTR). Contrast decay-halftime (T/2), maximal video-intensity (Imax) and area under the curve (Area) were derived by computer-assisted videodensitometry. After papaverine KTR showed a significant increase of T/2 (from 5.1 +/- 1.5 to 6.8 +/- 3.2 s, p < 0.05), of Imax (from 36 +/- 13 to 52 +/- 16 E, p < 0.002) and of Area (from 203 +/- 95 to 379 +/- 188 E*s, p < 0.002) compared to baseline values. In this group the ratios of hyperemia to baseline flow conditions were 1.5 +/- 0.4 (from 1.0 to 2.4) for Imax and 1.9 +/- 0.9 (from 1.1 to 3.9) for Area. In HHE and KHE, hyperemia induced no significant changes of T/2, Imax and Area. Heart rate was increased by 4.3% and mean aortic pressure was decreased by 6.2% in all groups after papaverine. Double-product was not altered significantly in any group. Myocardial contrast echocardiography revealed a significant increase in variables of contrast wash-out curves only in patients without proven heart disease. In contrast, no relevant changes of T/2, Imax and Area on average were observed in patients with coronary and hypertensive heart disease. Thus, myocardial contrast echocardiography seems to be suitable to document a reduced papaverine vasodilator response in these patients.