Are microbubbles free flowing tracers through the myocardium? Comparison of indicator-dilution curves obtained from dye dilution and echo contrast using harmonic power Doppler imaging

Background: Harmonic power Doppler imaging (H-PDI) has been introduced into the field of contrast echocardiography as a contrast-specific imaging moda lity. However, there has been considerable skepticism as to whether H-PDI w ould be quantifiable, because it depends on the destruction of microbubbles and has more complex signal processing than gray scale imaging. The aim of the present study was to evaluate the relationship between the concentrati on of microbubbles and the resulting H-PDI signals even under conditions wh ere bubble destruction is most likely. Furthermore, we evaluated whether mi crobubbles of Levovist freely pass the microcirculation, which is a prerequ isite for the assessment of myocardial blood flow. Methods and Results: A s trong positive correlation was found between the H-PDI signals and the amou nt of microbubbles up to the onset of acoustic shadowing (r = 0.968, P < 0. 001). Time-intensity curves for H-PDI of air-filled microbubbles were compa red with time-concentration curves of indocyanine green (ICG) in both a flo w phantom and a working heart setup. The mean transit times (MTTs) through the myocardium of both agents were compared after a bolus injection into th e left coronary artery. A close correlation was observed between 1/MTT and flow in both setups (r > 0.98 P < 0.0001). However, at high flow rates, the MTTs of the microbubbles were slightly, albeit not significantly, faster t han those of indocyanine green. Conclusions: We conclude that microbubbles fulfill the prerequisites of free flowing tracers through the myocardium. F urthermore, H-PDI technology allows a reliable assessment of time-concentra tion curves of air-filled microbubbles up to the onset of acoustic shadowin g.