Skip to main content
NCBI home page
The Texas Heart Institute Journal logoLink to The Texas Heart Institute Journal
. 1996;23(2):90–97.

Contrast echocardiography 1996. A review.

H R Villarraga 1, D A Foley 1, S L Mulvagh 1
PMCID: PMC325321  PMID: 8792539

Abstract

Remarkable advances in the field of contrast echocardiography have been made during the last decade. Interest in ultrasound contrast agents that strengthen the backscattered ultrasound signal and improve image display has stimulated further research. Echocardiographic contrast agents providing left ventricular cavity image enhancement after intravenous injection are now available. A role for contrast echocardiography in the assessment of myocardial perfusion has been established within the invasive clinical setting. With the development of newer contrast agents and new ultrasound technology, myocardial perfusion imaging using contrast echocardiography after venous injection is no longer the unattainable "holy grail," but is fast approaching clinical applicability.

Full text

PDF
90

Images in this article

91Image
on p.91
91Image
on p.91
92Image
on p.92

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aronson S., Lee B. K., Zaroff J. G., Wiencek J. G., Walker R., Feinstein S., Karp R. B. Myocardial distribution of cardioplegic solution after retrograde delivery in patients undergoing cardiac surgical procedures. J Thorac Cardiovasc Surg. 1993 Feb;105(2):214–221. [PubMed] [Google Scholar]
  2. Assad-Morell J. L., Seward J. B., Tajik A. J., Hagler D. J., Giuliani E. R., Ritter D. G. Echo-phonocardiographic and contrast studies in conditions associated with systemic arterial trunk overriding the ventricular septum: truncus arteriosus, tetralogy of Fallot, and pulmonary atresia with ventricular septal defect. Circulation. 1976 Apr;53(4):663–673. doi: 10.1161/01.cir.53.4.663. [DOI] [PubMed] [Google Scholar]
  3. Cheirif J., Narkiewicz-Jodko J. B., Hawkins H. K., Bravenec J. S., Quinones M. A., Mickelson J. K. Myocardial contrast echocardiography: relation of collateral perfusion to extent of injury and severity of contractile dysfunction in a canine model of coronary thrombosis and reperfusion. J Am Coll Cardiol. 1995 Aug;26(2):537–546. doi: 10.1016/0735-1097(95)80034-e. [DOI] [PubMed] [Google Scholar]
  4. Cheirif J., Zoghbi W. A., Bolli R., O'Neill P. G., Hoyt B. D., Quinones M. A. Assessment of regional myocardial perfusion by contrast echocardiography. II. Detection of changes in transmural and subendocardial perfusion during dipyridamole-induced hyperemia in a model of critical coronary stenosis. J Am Coll Cardiol. 1989 Nov 15;14(6):1555–1565. doi: 10.1016/0735-1097(89)90398-7. [DOI] [PubMed] [Google Scholar]
  5. Cheirif J., Zoghbi W. A., Raizner A. E., Minor S. T., Winters W. L., Jr, Klein M. S., De Bauche T. L., Lewis J. M., Roberts R., Quinones M. A. Assessment of myocardial perfusion in humans by contrast echocardiography. I. Evaluation of regional coronary reserve by peak contrast intensity. J Am Coll Cardiol. 1988 Apr;11(4):735–743. doi: 10.1016/0735-1097(88)90205-7. [DOI] [PubMed] [Google Scholar]
  6. Crouse L. J., Cheirif J., Hanly D. E., Kisslo J. A., Labovitz A. J., Raichlen J. S., Schutz R. W., Shah P. M., Smith M. D. Opacification and border delineation improvement in patients with suboptimal endocardial border definition in routine echocardiography: results of the Phase III Albunex Multicenter Trial. J Am Coll Cardiol. 1993 Nov 1;22(5):1494–1500. doi: 10.1016/0735-1097(93)90562-f. [DOI] [PubMed] [Google Scholar]
  7. Dittrich H. C., Bales G. L., Kuvelas T., Hunt R. M., McFerran B. A., Greener Y. Myocardial contrast echocardiography in experimental coronary artery occlusion with a new intravenously administered contrast agent. J Am Soc Echocardiogr. 1995 Jul-Aug;8(4):465–474. doi: 10.1016/s0894-7317(05)80333-5. [DOI] [PubMed] [Google Scholar]
  8. Eigler N. L., Schühlen H., Whiting J. S., Pfaff J. M., Zeiher A., Gu S. Digital angiographic impulse response analysis of regional myocardial perfusion. Estimation of coronary flow, flow reserve, and distribution volume by compartmental transit time measurement in a canine model. Circ Res. 1991 Mar;68(3):870–880. doi: 10.1161/01.res.68.3.870. [DOI] [PubMed] [Google Scholar]
  9. Fan P., Czuwala P. J., Nanda N. C., Rosenthal S. M., Yoganathan A. Comparison of various agents in contrast enhancement of color Doppler flow images: an in vitro study. Ultrasound Med Biol. 1993;19(1):45–57. doi: 10.1016/0301-5629(93)90017-i. [DOI] [PubMed] [Google Scholar]
  10. Feigenbaum H., Stone J. M., Lee D. A., Nasser W. K., Chang S. Identification of ultrasound echoes from the left ventricle by use of intracardiac injections of indocyanine green. Circulation. 1970 Apr;41(4):615–621. doi: 10.1161/01.cir.41.4.615. [DOI] [PubMed] [Google Scholar]
  11. Feinstein S. B., Cheirif J., Ten Cate F. J., Silverman P. R., Heidenreich P. A., Dick C., Desir R. M., Armstrong W. F., Quinones M. A., Shah P. M. Safety and efficacy of a new transpulmonary ultrasound contrast agent: initial multicenter clinical results. J Am Coll Cardiol. 1990 Aug;16(2):316–324. doi: 10.1016/0735-1097(90)90580-i. [DOI] [PubMed] [Google Scholar]
  12. Francis C. W., Onundarson P. T., Carstensen E. L., Blinc A., Meltzer R. S., Schwarz K., Marder V. J. Enhancement of fibrinolysis in vitro by ultrasound. J Clin Invest. 1992 Nov;90(5):2063–2068. doi: 10.1172/JCI116088. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Gottlieb S., Ernst A., Meltzer R. S. Effect of pressure on echocardiographic videodensity from sonicated albumin: an in vitro model. J Ultrasound Med. 1995 Feb;14(2):109–116. doi: 10.7863/jum.1995.14.2.109. [DOI] [PubMed] [Google Scholar]
  14. Gramiak R., Shah P. M. Echocardiography of the aortic root. Invest Radiol. 1968 Sep-Oct;3(5):356–366. doi: 10.1097/00004424-196809000-00011. [DOI] [PubMed] [Google Scholar]
  15. Grayburn P. A., Erickson J. M., Escobar J., Womack L., Velasco C. E. Peripheral intravenous myocardial contrast echocardiography using a 2% dodecafluoropentane emulsion: identification of myocardial risk area and infarct size in the canine model of ischemia. J Am Coll Cardiol. 1995 Nov 1;26(5):1340–1347. doi: 10.1016/0735-1097(95)00306-1. [DOI] [PubMed] [Google Scholar]
  16. Grill H. P., Brinker J. A., Taube J. C., Walford G. D., Midei M. G., Flaherty J. T., Weiss J. L. Contrast echocardiographic mapping of collateralized myocardium in humans before and after coronary angioplasty. J Am Coll Cardiol. 1990 Dec;16(7):1594–1600. doi: 10.1016/0735-1097(90)90306-a. [DOI] [PubMed] [Google Scholar]
  17. Harpaz D., Chen X., Francis C. W., Marder V. J., Meltzer R. S. Ultrasound enhancement of thrombolysis and reperfusion in vitro. J Am Coll Cardiol. 1993 May;21(6):1507–1511. doi: 10.1016/0735-1097(93)90331-t. [DOI] [PubMed] [Google Scholar]
  18. Heymann M. A., Payne B. D., Hoffman J. I., Rudolph A. M. Blood flow measurements with radionuclide-labeled particles. Prog Cardiovasc Dis. 1977 Jul-Aug;20(1):55–79. doi: 10.1016/s0033-0620(77)80005-4. [DOI] [PubMed] [Google Scholar]
  19. Ismail S., Jayaweera A. R., Goodman N. C., Camarano G. P., Skyba D. M., Kaul S. Detection of coronary stenoses and quantification of the degree and spatial extent of blood flow mismatch during coronary hyperemia with myocardial contrast echocardiography. Circulation. 1995 Feb 1;91(3):821–830. doi: 10.1161/01.cir.91.3.821. [DOI] [PubMed] [Google Scholar]
  20. Ito H., Tomooka T., Sakai N., Yu H., Higashino Y., Fujii K., Masuyama T., Kitabatake A., Minamino T. Lack of myocardial perfusion immediately after successful thrombolysis. A predictor of poor recovery of left ventricular function in anterior myocardial infarction. Circulation. 1992 May;85(5):1699–1705. doi: 10.1161/01.cir.85.5.1699. [DOI] [PubMed] [Google Scholar]
  21. Jayaweera A. R., Edwards N., Glasheen W. P., Villanueva F. S., Abbott R. D., Kaul S. In vivo myocardial kinetics of air-filled albumin microbubbles during myocardial contrast echocardiography. Comparison with radiolabeled red blood cells. Circ Res. 1994 Jun;74(6):1157–1165. doi: 10.1161/01.res.74.6.1157. [DOI] [PubMed] [Google Scholar]
  22. Kaul S., Glasheen W. P., Oliner J. D., Kelly P., Gascho J. A. Relation between anterograde blood flow through a coronary artery and the size of the perfusion bed it supplies: experimental and clinical implications. J Am Coll Cardiol. 1991 May;17(6):1403–1413. doi: 10.1016/s0735-1097(10)80154-8. [DOI] [PubMed] [Google Scholar]
  23. Kaul S., Kelly P., Oliner J. D., Glasheen W. P., Keller M. W., Watson D. D. Assessment of regional myocardial blood flow with myocardial contrast two-dimensional echocardiography. J Am Coll Cardiol. 1989 Feb;13(2):468–482. doi: 10.1016/0735-1097(89)90528-7. [DOI] [PubMed] [Google Scholar]
  24. Kaul S., Pandian N. G., Okada R. D., Pohost G. M., Weyman A. E. Contrast echocardiography in acute myocardial ischemia: I. In vivo determination of total left ventricular "area at risk". J Am Coll Cardiol. 1984 Dec;4(6):1272–1282. doi: 10.1016/s0735-1097(84)80149-7. [DOI] [PubMed] [Google Scholar]
  25. Keller M. W., Glasheen W., Smucker M. L., Burwell L. R., Watson D. D., Kaul S. Myocardial contrast echocardiography in humans. II. Assessment of coronary blood flow reserve. J Am Coll Cardiol. 1988 Oct;12(4):925–934. doi: 10.1016/0735-1097(88)90456-1. [DOI] [PubMed] [Google Scholar]
  26. Keller M. W., Segal S. S., Kaul S., Duling B. The behavior of sonicated albumin microbubbles within the microcirculation: a basis for their use during myocardial contrast echocardiography. Circ Res. 1989 Aug;65(2):458–467. doi: 10.1161/01.res.65.2.458. [DOI] [PubMed] [Google Scholar]
  27. Kemper A. J., O'Boyle J. E., Sharma S., Cohen C. A., Kloner R. A., Khuri S. F., Parisi A. F. Hydrogen peroxide contrast--enhanced two-dimensional echocardiography: real-time in vivo delineation of regional myocardial perfusion. Circulation. 1983 Sep;68(3):603–611. doi: 10.1161/01.cir.68.3.603. [DOI] [PubMed] [Google Scholar]
  28. Lang R. M., Feinstein S. B., Feldman T., Neumann A., Chua K. G., Borow K. M. Contrast echocardiography for evaluation of myocardial perfusion: effects of coronary angioplasty. J Am Coll Cardiol. 1986 Jul;8(1):232–235. doi: 10.1016/s0735-1097(86)80118-8. [DOI] [PubMed] [Google Scholar]
  29. Lauer C. G., Burge R., Tang D. B., Bass B. G., Gomez E. R., Alving B. M. Effect of ultrasound on tissue-type plasminogen activator-induced thrombolysis. Circulation. 1992 Oct;86(4):1257–1264. doi: 10.1161/01.cir.86.4.1257. [DOI] [PubMed] [Google Scholar]
  30. Lenfant C. NHLBI funding policies. Enhancing stability, predictability, and cost control. Circulation. 1994 Jul;90(1):1–1. doi: 10.1161/01.cir.90.1.1. [DOI] [PubMed] [Google Scholar]
  31. Lim Y. J., Nanto S., Masuyama T., Kodama K., Ikeda T., Kitabatake A., Kamada T. Visualization of subendocardial myocardial ischemia with myocardial contrast echocardiography in humans. Circulation. 1989 Feb;79(2):233–244. doi: 10.1161/01.cir.79.2.233. [DOI] [PubMed] [Google Scholar]
  32. Lim Y. J., Nanto S., Masuyama T., Kodama K., Kohama A., Kitabatake A., Kamada T. Coronary collaterals assessed with myocardial contrast echocardiography in healed myocardial infarction. Am J Cardiol. 1990 Sep 1;66(5):556–561. doi: 10.1016/0002-9149(90)90481-f. [DOI] [PubMed] [Google Scholar]
  33. Meltzer R. S., Tickner E. G., Sahines T. P., Popp R. L. The source of ultrasound contrast effect. J Clin Ultrasound. 1980 Apr;8(2):121–127. doi: 10.1002/jcu.1870080205. [DOI] [PubMed] [Google Scholar]
  34. Mizushige K., DeMaria A. N., Toyama Y., Morita H., Senda S., Matsuo H. Contrast echocardiography for evaluation of left ventricular flow dynamics using densitometric analysis. Circulation. 1993 Aug;88(2):588–595. doi: 10.1161/01.cir.88.2.588. [DOI] [PubMed] [Google Scholar]
  35. Mor-Avi V., Shroff S. G., Robinson K. A., Ng A. F., Cholley B. P., Marcus R. H., Lang R. M. Effects of left ventricular pressure on sonicated albumin microbubbles: evaluation using an isolated rabbit heart model. J Am Coll Cardiol. 1994 Dec;24(7):1779–1785. doi: 10.1016/0735-1097(94)90187-2. [DOI] [PubMed] [Google Scholar]
  36. Mudra H., Zwehl W., Klauss V., Kreuzer E., Haufe M. C., Angermann C., Theisen K. Intraoperative myocardial contrast echocardiography for assessment of regional bypass perfusion. Am J Cardiol. 1990 Nov 1;66(15):1077–1081. doi: 10.1016/0002-9149(90)90508-x. [DOI] [PubMed] [Google Scholar]
  37. Mulvagh S. L., Foley D. A., Aeschbacher B. C., Klarich K. K., Seward J. B. Second harmonic imaging of an intravenously administered echocardiographic contrast agent: Visualization of coronary arteries and measurement of coronary blood flow. J Am Coll Cardiol. 1996 May;27(6):1519–1525. doi: 10.1016/0735-1097(95)00619-2. [DOI] [PubMed] [Google Scholar]
  38. Nakatani S., Imanishi T., Terasawa A., Beppu S., Nagata S., Miyatake K. Clinical application of transpulmonary contrast-enhanced Doppler technique in the assessment of severity of aortic stenosis. J Am Coll Cardiol. 1992 Oct;20(4):973–978. doi: 10.1016/0735-1097(92)90200-7. [DOI] [PubMed] [Google Scholar]
  39. Ophir J., Parker K. J. Contrast agents in diagnostic ultrasound. Ultrasound Med Biol. 1989;15(4):319–333. doi: 10.1016/0301-5629(89)90044-6. [DOI] [PubMed] [Google Scholar]
  40. Padial L. R., Chen M. H., Vuille C., Guerrero J. L., Weyman A. E., Picard M. H. Pulsatile pressure affects the disappearance of echocardiographic contrast agents. J Am Soc Echocardiogr. 1995 May-Jun;8(3):285–292. doi: 10.1016/s0894-7317(05)80039-2. [DOI] [PubMed] [Google Scholar]
  41. Perchet H., Dupouy P., Duval-Moulin A. M., Hittinger L., Pelle G., Brun P., Castaigne A., Geschwind H., Dubois-Randé J. L. Improvement of subendocardial myocardial perfusion after percutaneous transluminal coronary angioplasty. A myocardial contrast echocardiography study with correlation between myocardial contrast reserve and Doppler coronary reserve. Circulation. 1995 Mar 1;91(5):1419–1426. doi: 10.1161/01.cir.91.5.1419. [DOI] [PubMed] [Google Scholar]
  42. Porter T. R., D'Sa A., Pesko L., Turner C., Nath A., Vetrovec G. W., Nixon J. V. Usefulness of myocardial contrast echocardiography in detecting the immediate changes in anterograde blood flow reserve after coronary angioplasty. Am J Cardiol. 1993 Apr 15;71(11):893–896. doi: 10.1016/0002-9149(93)90902-o. [DOI] [PubMed] [Google Scholar]
  43. Porter T. R., D'Sa A., Turner C., Jones L. A., Minisi A. J., Mohanty P. K., Vetrovec G. W., Nixon J. V. Myocardial contrast echocardiography for the assessment of coronary blood flow reserve: validation in humans. J Am Coll Cardiol. 1993 Feb;21(2):349–355. doi: 10.1016/0735-1097(93)90674-p. [DOI] [PubMed] [Google Scholar]
  44. Porter T. R., Xie F., Kricsfeld A., Kilzer K. Noninvasive identification of acute myocardial ischemia and reperfusion with contrast ultrasound using intravenous perfluoropropane-exposed sonicated dextrose albumin. J Am Coll Cardiol. 1995 Jul;26(1):33–40. doi: 10.1016/0735-1097(95)00132-j. [DOI] [PubMed] [Google Scholar]
  45. Porter T. R., Xie F. Transient myocardial contrast after initial exposure to diagnostic ultrasound pressures with minute doses of intravenously injected microbubbles. Demonstration and potential mechanisms. Circulation. 1995 Nov 1;92(9):2391–2395. doi: 10.1161/01.cir.92.9.2391. [DOI] [PubMed] [Google Scholar]
  46. Porter T. R., Xie F. Visually discernible myocardial echocardiographic contrast after intravenous injection of sonicated dextrose albumin microbubbles containing high molecular weight, less soluble gases. J Am Coll Cardiol. 1995 Feb;25(2):509–515. doi: 10.1016/0735-1097(94)00376-2. [DOI] [PubMed] [Google Scholar]
  47. Ragosta M., Camarano G., Kaul S., Powers E. R., Sarembock I. J., Gimple L. W. Microvascular integrity indicates myocellular viability in patients with recent myocardial infarction. New insights using myocardial contrast echocardiography. Circulation. 1994 Jun;89(6):2562–2569. doi: 10.1161/01.cir.89.6.2562. [DOI] [PubMed] [Google Scholar]
  48. Reisner S. A., Ong L. S., Lichtenberg G. S., Shapiro J. R., Amico A. F., Allen M. N., Meltzer R. S. Quantitative assessment of the immediate results of coronary angioplasty by myocardial contrast echocardiography. J Am Coll Cardiol. 1989 Mar 15;13(4):852–859. doi: 10.1016/0735-1097(89)90227-1. [DOI] [PubMed] [Google Scholar]
  49. Sabia P. J., Powers E. R., Jayaweera A. R., Ragosta M., Kaul S. Functional significance of collateral blood flow in patients with recent acute myocardial infarction. A study using myocardial contrast echocardiography. Circulation. 1992 Jun;85(6):2080–2089. doi: 10.1161/01.cir.85.6.2080. [DOI] [PubMed] [Google Scholar]
  50. Sanders W. E., Jr, Cheirif J., Desir R., Zoghbi W. A., Hoyt B. D., Schulz P. E., Quiñones M. A. Contrast opacification of left ventricular myocardium following intravenous administration of sonicated albumin microspheres. Am Heart J. 1991 Dec;122(6):1660–1665. doi: 10.1016/0002-8703(91)90284-o. [DOI] [PubMed] [Google Scholar]
  51. Schlief R., Schürmann R., Niendorf H. P. Blood-pool enhancement with SH U 508 A. Results of phase II clinical trials. Invest Radiol. 1991 Nov;26 (Suppl 1):S188–S200. doi: 10.1097/00004424-199111001-00064. [DOI] [PubMed] [Google Scholar]
  52. Schrope B. A., Newhouse V. L. Second harmonic ultrasonic blood perfusion measurement. Ultrasound Med Biol. 1993;19(7):567–579. doi: 10.1016/0301-5629(93)90080-8. [DOI] [PubMed] [Google Scholar]
  53. Schrope B., Newhouse V. L., Uhlendorf V. Simulated capillary blood flow measurement using a nonlinear ultrasonic contrast agent. Ultrason Imaging. 1992 Apr;14(2):134–158. doi: 10.1177/016173469201400204. [DOI] [PubMed] [Google Scholar]
  54. Schröder K., Agrawal R., Völler H., Schlief R., Schröder R. Improvement of endocardial border delineation in suboptimal stress-echocardiograms using the new left heart contrast agent SH U 508 A. Int J Card Imaging. 1994 Mar;10(1):45–51. doi: 10.1007/BF01151580. [DOI] [PubMed] [Google Scholar]
  55. Seward J. B., Tajik A. J., Hagler D. J., Ritter D. G. Contrast echocardiography in single or common ventricle. Circulation. 1977 Mar;55(3):513–519. doi: 10.1161/01.cir.55.3.513. [DOI] [PubMed] [Google Scholar]
  56. Seward J. B., Tajik A. J., Spangler J. G., Ritter D. G. Echocardiographic contrast studies: initial experience. Mayo Clin Proc. 1975 Apr;50(4):163–192. [PubMed] [Google Scholar]
  57. Skyba D. M., Jayaweera A. R., Goodman N. C., Ismail S., Camarano G., Kaul S. Quantification of myocardial perfusion with myocardial contrast echocardiography during left atrial injection of contrast. Implications for venous injection. Circulation. 1994 Sep;90(3):1513–1521. doi: 10.1161/01.cir.90.3.1513. [DOI] [PubMed] [Google Scholar]
  58. Smith S. C., Jr AHA president's letter. Circulation. 1995 Jul 1;92(1):1–1. [PubMed] [Google Scholar]
  59. Smith S. C., Jr AHA president's letter. Circulation. 1995 Jul 1;92(1):1–1. [PubMed] [Google Scholar]
  60. Tachibana K., Tachibana S. Albumin microbubble echo-contrast material as an enhancer for ultrasound accelerated thrombolysis. Circulation. 1995 Sep 1;92(5):1148–1150. doi: 10.1161/01.cir.92.5.1148. [DOI] [PubMed] [Google Scholar]
  61. Tei C., Sakamaki T., Shah P. M., Meerbaum S., Shimoura K., Kondo S., Corday E. Myocardial contrast echocardiography: a reproducible technique of myocardial opacification for identifying regional perfusion deficits. Circulation. 1983 Mar;67(3):585–593. doi: 10.1161/01.cir.67.3.585. [DOI] [PubMed] [Google Scholar]
  62. Ten Cate F. J., Widimsky P., Cornel J. H., Waldstein D. J., Serruys P. W., Waaler A. Intracoronary albunex. Its effects on left ventricular hemodynamics, function, and coronary sinus flow in humans. Circulation. 1993 Nov;88(5 Pt 1):2123–2127. doi: 10.1161/01.cir.88.5.2123. [DOI] [PubMed] [Google Scholar]
  63. Vandenberg B. F., Melton H. E. Acoustic lability of albumin microspheres. J Am Soc Echocardiogr. 1994 Nov-Dec;7(6):582–589. doi: 10.1016/s0894-7317(14)80080-1. [DOI] [PubMed] [Google Scholar]
  64. Villanueva F. S., Spotnitz W. D., Jayaweera A. R., Dent J., Gimple L. W., Kaul S. On-line intraoperative quantitation of regional myocardial perfusion during coronary artery bypass graft operations with myocardial contrast two-dimensional echocardiography. J Thorac Cardiovasc Surg. 1992 Dec;104(6):1524–1531. [PubMed] [Google Scholar]
  65. Vuille C., Nidorf M., Morrissey R. L., Newell J. B., Weyman A. E., Picard M. H. Effect of static pressure on the disappearance rate of specific echocardiographic contrast agents. J Am Soc Echocardiogr. 1994 Jul-Aug;7(4):347–354. doi: 10.1016/s0894-7317(14)80192-2. [DOI] [PubMed] [Google Scholar]
  66. Widimsky P., Cornel J. H., ten Cate F. J. Evaluation of collateral blood flow by myocardial contrast enhanced echocardiography. Br Heart J. 1988 Jan;59(1):20–22. doi: 10.1136/hrt.59.1.20. [DOI] [PMC free article] [PubMed] [Google Scholar]
  67. Wu X. S., Ewert D. L., Liu Y. H., Ritman E. L. In vivo relation of intramyocardial blood volume to myocardial perfusion. Evidence supporting microvascular site for autoregulation. Circulation. 1992 Feb;85(2):730–737. doi: 10.1161/01.cir.85.2.730. [DOI] [PubMed] [Google Scholar]
  68. Ziskin M. C., Bonakdarpour A., Weinstein D. P., Lynch P. R. Contrast agents for diagnostic ultrasound. Invest Radiol. 1972 Nov-Dec;7(6):500–505. doi: 10.1097/00004424-197211000-00006. [DOI] [PubMed] [Google Scholar]
  69. de Jong N., Ten Cate F. J., Lancée C. T., Roelandt J. R., Bom N. Principles and recent developments in ultrasound contrast agents. Ultrasonics. 1991 Jul;29(4):324–330. doi: 10.1016/0041-624x(91)90030-c. [DOI] [PubMed] [Google Scholar]
  70. deFilippi C. R., Willett D. L., Irani W. N., Eichhorn E. J., Velasco C. E., Grayburn P. A. Comparison of myocardial contrast echocardiography and low-dose dobutamine stress echocardiography in predicting recovery of left ventricular function after coronary revascularization in chronic ischemic heart disease. Circulation. 1995 Nov 15;92(10):2863–2868. doi: 10.1161/01.cir.92.10.2863. [DOI] [PubMed] [Google Scholar]
  71. von Bibra H., Sutherland G., Becher H., Neudert J., Nihoyannopoulos P. Clinical evaluation of left heart Doppler contrast enhancement by a saccharide-based transpulmonary contrast agent. The Levovist Cardiac Working Group. J Am Coll Cardiol. 1995 Feb;25(2):500–508. doi: 10.1016/0735-1097(94)00404-e. [DOI] [PubMed] [Google Scholar]

Articles from Texas Heart Institute Journal are provided here courtesy of Texas Heart Institute

RESOURCES