ASSESSMENT OF MYOCARDIAL FLOW RESERVE BY CONTRAST ECHOCARDIOGRAPHY

In order to determine whether changes in myocardial perfusion can be a ssessed by myocardial contrast echocardiography, intracoronary injecti ons 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). 1 3 patients showed coronary artery disease (KHE), 6 patients hypertensi ve heart disease (HHE), and 12 patients had no proven heart disease (K TR). Contrast decay-halftime (T/2), maximal video-intensity (Imax) and area under the curve (Area) were derived by computer-assisted videode nsitometry. 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 +/- 18 8 E s, p < 0.002) compared to baseline values. In this group the rat ios 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 Are a. Heart rate was increased by 4.3% and mean aortic pressure was decre ased by 6.2% in all groups after papaverine. Double-product was not al tered significantly in any group. Myocardial contrast echocardiography revealed a significant increase in variables of contrast wash-out cur ves only in patients without proven heart disease. In contrast, no rel evant changes of T/2, Imax and Area on average were observed in patien ts with coronary and hypertensive heart disease. Thus, myocardial cont rast echocardiography seems to be suitable to document a reduced papav erine vasodilator response in these patients.