Abstract 2686: Can Real-Time 3D Echocardiography Be Used to Assess Myocardial Perfusion?

Abstract

Introduction: 2D low mechanical index (LMI) contrast specific myocardial perfusion imaging is now an accepted technique. Advancements in technology now allow us to use this technique in combination with real-time 3D echo. We assessed the hypothesis that real time 3D myocardial contrast echo (RT3DMCE) is feasible in a clinical setting. Methods: 46 consecutive patients (24 male) referred for contrast enhanced echocardiography were imaged using a 3D scanner equipped with novel 3D LMI power modulation software. All patients underwent 2D contrast echo and real-time 3D apical full volume acquisition, during contrast infusion. Datasets were taken in left ventricular opacification (LVO) and LMI perfusion modes. These were then evaluated segmentally for wall motion and myocardial contrast enhancement, relative to the LVO mode. Results: A total of 736 left ventricular segments were analysed. Wall motion and perfusion could be assessed in 726 (98.6%) and 721(98%) respectively of the 2D segments and 708 (96.2%) and 701(95.2%) of the 3D segments. Although p=<0.05 for these comparisons, they showed good agreement: 97.6% ( kappa 0.52) for wall motion and 97.3% ( kappa 0.61) for perfusion. 661 segments had normal wall motion and thickening in 2D. Of these, normal 3D myocardial opacification was seen in 91.8% of apical, 85% of mid and 77.2% of basal segments. 34 segments were akinetic with no 2D evidence of perfusion and of these RT3DMCE successfully identified a perfusion defect in 31 (91% p=NS). Conclusion: Evaluation of myocardial perfusion using RT3DMCE is feasible in most segments. In the future it has the potential to specify accurate location of perfusion defects and quantify volumes.