Quantitative Stress Echocardiography In Coronary Artery Disease Using Contrast-based Myocardial Blood Flow Measurements: Prospective Comparison With Coronary Angiography

摘要

Aim: To test whether quantitative stress echocardiogra-phy using contrast-based myocardial blood flow (MBF, ml.min~(-1).g~(-1)) measurements can detect coronary artery disease in humans.rnMethods: 48 patients eligible for pharmacological stres testing by myocardial contrast echocardiography (MCE) and willing to undergo subsequent coronary angiograph were prospectively enrolled in the study. Baseline and adenosine-induced (140 μg.kg~(-1).min~(-1)) hyperaemic MBF was analysed according to a three-coronary-artery-territory model. Vascular territories were categorised int three groups with increasing stenosis severity defined a percentage diameter reduction by quantitative coronary angiography. Results: Myocardial blood flow reserve (MBFR)-that is the ratio of hyperaemic to baseline MBF, was obtained in 128 (89%) territories. Mean (SD) baseline MBF was 1.07 (0.395) ml.min~(-1).g~(-1) and did not differ between territories supplied by coronary arteries with mild (＜50％, stenosis), moderate (50%-74% stenosis) or severe (≥75% stenosis) disease. Mean (SD) hyperaemic MBF and MBFB were 2.509 (1.078) ml.min~(-1).g~(-1) and 2.54 (1.03), respectively, and decreased linearly (r~2 = 0.21 an r~2 = 0.39) with stenosis severity. BOC analysis revealed that a territorial MBFR <1.94 detected ≥50% stenosis with 89% sensitivity and 92% specificity. Conclusion: Quantitative stress testing based on MBF measurements derived from contrast echocardiography is a new method for the non-invasive and reliable assessment of coronary artery disease in humans.