Myocardial perfusion by intravenous echo contrast and by nuclear imaging

The combination of harmonic intermittent imaging, Power Dopplerand intravenous echo contrast administration provides information regarding myocardial perfusion. The aim of this study was to examine the capability of this method to detect perfusion defects in patients (pts) with abnormal myocardial scintigraphy. Study population consisted of 32 pts (25 males, age 39-84 years), with previous Q (17 pts) or non-Q (11 pts) myocardial infarction,showing perfusion defects at rest 201 Thallium SPECT. Myocardial contrast enhancement (MCE) was achieved by intravenous administration of a galactose-based contrast agent (Levovist, Germany). Contrast echo images (in the apical 4-chamber view) and nuclear scans (in the corresponding horizontal long-axis view) were divided into 6 segments according to a 16-segment model; myocardial perfusion was scored as 1 (normal), 0.5 (patchy or inhomogeneous perfusion) or 0 (no detectable perfusion). Interpretable contrast echo images were obtained in 184 segments. Out of 34 segments with a Thallium score of zero, 23 showed an MCE score of zero, 6 a score of 0.5 and only 5 a score of 1. Out of 62 segments with a nuclear score of 0.5, 32 also showed an MCE score of 0,5 and 8 a score of O. Of the 88 segments with a Thallium score of one, 77 showed an MCE score of 1 and no one segment a score of 0. Out of 96 segments with abnormal Thallium uptake, 69 showed abnormal contrast enhancement; out of 88 segments with normal Thallium uptake, 77 showed normal contrast enhancement (Kappa 0.589). The correlation coefficient between perfusion scores was 0.67. Thus, myocardial perfusion defects can be non invasively assessed by intravenous echo contrast during harmonic intermittent Power Doppler