Myocardial Contrast Echocardiography for the Detection of Coronary Artery Disease in Patients with Global Hypokinesis Admitted for First-Onset Acute Heart Failure: Pilot Study
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Background: The non-invasive differentiation of ischemic and nonischemic acute heart failure (AHF) not resulting fromacute myocardial infarction is difficult and has therapeutic and prognostic implications. The aim of this study was to assesswhether resting myocardial contrast echocardiography (MCE) can detect coronary artery disease (CAD) in patients with decreasedleft ventricular (LV) systolic function and global hypokinesis presenting with AHF. Methods: Twenty-one consecutive patients underwent low-power real-time MCE based on color-coded pulse inversionDoppler. Standard apical LV views were acquired during contrast IV infusion of Definity®. Following transient microbubblesdestruction, the contrast replenishment rate (β), reflecting myocardial blood flow velocity, was derived by plotting signalintensity vs. time and fitting data to the exponential function: y (t) = A (1 - e-β(t-t0)) + C. Results: Of the 21 (mean age 56.6 ± 13.6 years) patients, 5 (23.8%) demonstrated flow-limiting CAD (> 70% of luminaldiameter narrowing). The mean ± standard deviation of LV ejection fraction was 29.6 ± 8.6%. Quantitative MCE analysis wasfeasible in 258 of 378 segments (68.3%). There were no significant difference in “β” and “Aβ” in patients without and withCAD (0.48 ± 0.27 vs. 0.45 ± 0.25, p = 0.453 for β and 2.99 ± 2.23 vs. 3.68 ± 3.13, p = 0.059 for Aβ, respectively). Nocontrast-related side effects were reported. Conclusion: Resting quantitative MCE analysis in patients with AHF was feasible, however, the parameters did not aid indetecting of CAD.
Abstract
Background: The non-invasive differentiation of ischemic and nonischemic acute heart failure (AHF) not resulting fromacute myocardial infarction is difficult and has therapeutic and prognostic implications. The aim of this study was to assesswhether resting myocardial contrast echocardiography (MCE) can detect coronary artery disease (CAD) in patients with decreasedleft ventricular (LV) systolic function and global hypokinesis presenting with AHF. Methods: Twenty-one consecutive patients underwent low-power real-time MCE based on color-coded pulse inversionDoppler. Standard apical LV views were acquired during contrast IV infusion of Definity®. Following transient microbubblesdestruction, the contrast replenishment rate (β), reflecting myocardial blood flow velocity, was derived by plotting signalintensity vs. time and fitting data to the exponential function: y (t) = A (1 - e-β(t-t0)) + C. Results: Of the 21 (mean age 56.6 ± 13.6 years) patients, 5 (23.8%) demonstrated flow-limiting CAD (> 70% of luminaldiameter narrowing). The mean ± standard deviation of LV ejection fraction was 29.6 ± 8.6%. Quantitative MCE analysis wasfeasible in 258 of 378 segments (68.3%). There were no significant difference in “β” and “Aβ” in patients without and withCAD (0.48 ± 0.27 vs. 0.45 ± 0.25, p = 0.453 for β and 2.99 ± 2.23 vs. 3.68 ± 3.13, p = 0.059 for Aβ, respectively). Nocontrast-related side effects were reported. Conclusion: Resting quantitative MCE analysis in patients with AHF was feasible, however, the parameters did not aid indetecting of CAD.
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