A method of detecting and quantifying severity of myocardial perfusion defects with intravenous ultrasound contrast and breath holding during stress echocardiography

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Abstract

Although breath holding is commonly used to improve and maintain image quality during stress echocardiography, its effects on the qualitative and quantitative analysis of myocardial contrast enhancement (MCE) following intravenously injected microbubbles is unknown. The purpose of this study was to determine how breath holding affects MCE following either an intravenous bolus or continuous infusion of perfluorocarbon containing microbubbles. In 48 patients, intravenous Optison was given at peak dobutamine stress to assess myocardial perfusion. The degree of myocardial opacification was assessed immediately following a breath hold in inspiration (BHini), at the end of a breath hold (BHterm), and following expiration and a subsequent second breath hold (BHreinsp). Pulmonary venous time velocity integrals were recorded during these different phases as well. Eleven patients had quantitative coronary angiography. Mean duration of the breath hold was 7 ± 1 seconds. Pulmonary venous return fell by 29% ± 18% at BHterm (P < 0.001). There was complete disappearance of MCE at BHterm in 27 of 35 bolus injection patients at peak stress, and no return of MCE following flash destruction during breath holding in 11 of 13 patients receiving continuous infusions. BHreinsp resulted in a boluslike return of contrast, with a transient, bright MCE in 44 of 48 patients, and a time intensity plot that resembled a gamma variate function. Perfusion defects were visualized in 25 patients during BHini and 28 patients during BHreinsp. Coronary artery territory agreement between perfusion assessed during BHini and BHreinsp and quantitative coronary angiography was 76% and 81%, respectively.

Original languageEnglish (US)
Pages (from-to)411-422
Number of pages12
JournalEchocardiography
Volume20
Issue number5
DOIs
StatePublished - Jul 1 2003

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Breath Holding
Stress Echocardiography
Perfusion
Microbubbles
Coronary Angiography
Fluorocarbons
Lung
Dobutamine
Coronary Vessels
Injections

Keywords

  • Microbubbles
  • Myocardial contrast
  • Pulmonary venous return
  • Respiration

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

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title = "A method of detecting and quantifying severity of myocardial perfusion defects with intravenous ultrasound contrast and breath holding during stress echocardiography",
abstract = "Although breath holding is commonly used to improve and maintain image quality during stress echocardiography, its effects on the qualitative and quantitative analysis of myocardial contrast enhancement (MCE) following intravenously injected microbubbles is unknown. The purpose of this study was to determine how breath holding affects MCE following either an intravenous bolus or continuous infusion of perfluorocarbon containing microbubbles. In 48 patients, intravenous Optison was given at peak dobutamine stress to assess myocardial perfusion. The degree of myocardial opacification was assessed immediately following a breath hold in inspiration (BHini), at the end of a breath hold (BHterm), and following expiration and a subsequent second breath hold (BHreinsp). Pulmonary venous time velocity integrals were recorded during these different phases as well. Eleven patients had quantitative coronary angiography. Mean duration of the breath hold was 7 ± 1 seconds. Pulmonary venous return fell by 29{\%} ± 18{\%} at BHterm (P < 0.001). There was complete disappearance of MCE at BHterm in 27 of 35 bolus injection patients at peak stress, and no return of MCE following flash destruction during breath holding in 11 of 13 patients receiving continuous infusions. BHreinsp resulted in a boluslike return of contrast, with a transient, bright MCE in 44 of 48 patients, and a time intensity plot that resembled a gamma variate function. Perfusion defects were visualized in 25 patients during BHini and 28 patients during BHreinsp. Coronary artery territory agreement between perfusion assessed during BHini and BHreinsp and quantitative coronary angiography was 76{\%} and 81{\%}, respectively.",
keywords = "Microbubbles, Myocardial contrast, Pulmonary venous return, Respiration",
author = "Porter, {Thomas Richard} and O'Leary, {Edward Lewis} and Mary Silver and Heidi Oehlke and Feng Xie",
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T1 - A method of detecting and quantifying severity of myocardial perfusion defects with intravenous ultrasound contrast and breath holding during stress echocardiography

AU - Porter, Thomas Richard

AU - O'Leary, Edward Lewis

AU - Silver, Mary

AU - Oehlke, Heidi

AU - Xie, Feng

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N2 - Although breath holding is commonly used to improve and maintain image quality during stress echocardiography, its effects on the qualitative and quantitative analysis of myocardial contrast enhancement (MCE) following intravenously injected microbubbles is unknown. The purpose of this study was to determine how breath holding affects MCE following either an intravenous bolus or continuous infusion of perfluorocarbon containing microbubbles. In 48 patients, intravenous Optison was given at peak dobutamine stress to assess myocardial perfusion. The degree of myocardial opacification was assessed immediately following a breath hold in inspiration (BHini), at the end of a breath hold (BHterm), and following expiration and a subsequent second breath hold (BHreinsp). Pulmonary venous time velocity integrals were recorded during these different phases as well. Eleven patients had quantitative coronary angiography. Mean duration of the breath hold was 7 ± 1 seconds. Pulmonary venous return fell by 29% ± 18% at BHterm (P < 0.001). There was complete disappearance of MCE at BHterm in 27 of 35 bolus injection patients at peak stress, and no return of MCE following flash destruction during breath holding in 11 of 13 patients receiving continuous infusions. BHreinsp resulted in a boluslike return of contrast, with a transient, bright MCE in 44 of 48 patients, and a time intensity plot that resembled a gamma variate function. Perfusion defects were visualized in 25 patients during BHini and 28 patients during BHreinsp. Coronary artery territory agreement between perfusion assessed during BHini and BHreinsp and quantitative coronary angiography was 76% and 81%, respectively.

AB - Although breath holding is commonly used to improve and maintain image quality during stress echocardiography, its effects on the qualitative and quantitative analysis of myocardial contrast enhancement (MCE) following intravenously injected microbubbles is unknown. The purpose of this study was to determine how breath holding affects MCE following either an intravenous bolus or continuous infusion of perfluorocarbon containing microbubbles. In 48 patients, intravenous Optison was given at peak dobutamine stress to assess myocardial perfusion. The degree of myocardial opacification was assessed immediately following a breath hold in inspiration (BHini), at the end of a breath hold (BHterm), and following expiration and a subsequent second breath hold (BHreinsp). Pulmonary venous time velocity integrals were recorded during these different phases as well. Eleven patients had quantitative coronary angiography. Mean duration of the breath hold was 7 ± 1 seconds. Pulmonary venous return fell by 29% ± 18% at BHterm (P < 0.001). There was complete disappearance of MCE at BHterm in 27 of 35 bolus injection patients at peak stress, and no return of MCE following flash destruction during breath holding in 11 of 13 patients receiving continuous infusions. BHreinsp resulted in a boluslike return of contrast, with a transient, bright MCE in 44 of 48 patients, and a time intensity plot that resembled a gamma variate function. Perfusion defects were visualized in 25 patients during BHini and 28 patients during BHreinsp. Coronary artery territory agreement between perfusion assessed during BHini and BHreinsp and quantitative coronary angiography was 76% and 81%, respectively.

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