Myocardial contrast two-dimensional echocardiography: Initial observations during cardiac catheterization

Myocardial contrast two-dimensional (2D) echocardiography is a relatively new technique which was developed and validated in animals to determine myocardial perfusion. However, human studies are scarce. Therefore, myocardial contrast 2D echocardiography was performed in 32 patients with suspected coronary artery disease immediately after coronary arteriography. Two milliliters of sonicated iopamidol (microbubbles size 12 ± 4 μm) was injected intracoronarily during continuous recording of echocardiographic apical four-chamber view. Visible myocardial contrast was achieved in 82% of patients (25 patients) and 62% of injections (96 injections). Perfusion defects were detected in 5 of 6 patients with >90% stenosis without collateral circulation and in none of the 7 patients with collateral flow. Normally contracting segments were opacified in every instance, while this occurred only in 7 of 15 areas with contraction abnormalities. No wall motion abnormalities resulted from intracoronary sonicated iopamidol. Minor transient electrocardiographic changes (ST-T segment changes) were noted, which were similar as seen after routine coronary arteriography. Patients showed no complaints after injection of the echocontrast. Myocardial contrast 2D echocardiography is a potential useful method for the real-time analysis of myocardial perfusion in humans.