Contrast dobutamine stress myocardial perfusion echocardiography: current methodology and clinical applications

Abstract

Accurate evaluation of regional systolic wall thickening by echocardiography is largely dependent on adequate endocardial border resolution. Despite the recent introduction of tissue harmonic imaging, 15-20% of patients have poor endocardial border definition. Even with the use of ultrasonic contrast agents and resulting improvement in the endocardial delineation, conventional dobutamine stress echocardiography, though it has a high sensitivity for the diagnosis of coronary artery disease in patients with multivessel disease on coronary angiography, has limited ability to diagnose multivessel disease on the basis of inducible wall motion abnormalities in multivessel distributions. As in the ischemic cascade during demand stress myocardial perfusion abnormalities precede wall motion abnormalities, techniques which image myocardial perfusion as compared to wall motion are able to detect functionally significant coronary artery disease at an earlier stage and potentially at a submaximal stress. With real time myocardial perfusion imaging it is possible to simultaneously assess myocardial perfusion and function not only at rest but also during stress, which makes it a sensitive technique to detect and risk- stratify flow limiting coronary artery disease as compared to conventional wall motion imaging during stress. Furthermore, it has now become feasible to assess the changes in myocardial blood flow that occur during stress testing with the availability of softwares which makes it possible to quantitatively analyse these images, potentially improving the sensitivity and specificity of contrast echocardiography even further. © 2006 The European Society of Cardiology. Published by Elsevier Ltd. All rights reserved.