Real-time visualization of myocardial perfusion and wall thickening in human beings with intravenous ultrasonographic contrast and accelerated intermittent harmonic imaging

Previous work has demonstrated that at higher peak negative pressures, microbubbles are destroyed by diagnostic ultrasonography. At lower pressures (lower mechanical index), less destruction occurs but enhanced contrast persists. In animals, this lower mechanical index has resulted in enhanced contrast after administration of intravenous microbubbles with intermittent imaging at faster frame rates. We tested whether this accelerated intermittent imaging technique could produce myocardial contrast and detect myocardial perfusion abnormalities in 25 patients (10 with normal wall motion, 15 after myocardial infarction). Three independent reviewers detected persistent myocardial contrast defects within the infarct zone throughout the cardiac cycle in 9 of the 15 patients after acute myocardial infarction; the presence of such defects was predictive of a persistent regional wall motion abnormality at 4-week follow-up. Interobserver agreement on regional contrast enhancement ranged from 88% to 90%. We conclude that accelerated intermittent imaging permits real-time visualization of myocardial blood flow and wall thickening.