Quantitative contrast stress echocardiography in assessment of restenosis after percutaneous coronary intervention in stable coronary artery disease

Abstract

Aims: Quantitative contrast stress echocardiography (CSE) can assess regional myocardial perfusion. The aim of this study was to evaluate the performance of quantitative CSE in the detection of restenosis after percutaneous coronary intervention (PCI). Methods and results: Thirty-three patients with stable coronary artery disease, scheduled for PCI, underwent CSE and quantitative coronary angiography (QCA) before and 9 months after PCI. Regional myocardial perfusion was analysed blinded to QCA results. QCA identified 38 significant stenoses (≥50 diameter reduction). Before PCI, perfusion during stress was significantly reduced in regions supplied by stenotic arteries; blood flow velocity (Δβ) -3.9 (-9.0 to 0.5) s -1, perfusion rate (ΔA×β) -175.0 (-518.0 to 58.5) s-1, and refilling time (Δrt) 210 (-22 to 452)ms, compared with the perfusion increase seen in regions supplied by non-stenotic arteries; Δβ 1.6 (-0.7 to 4.4) s-1, ΔA×β 151.7 (-67.0 to 300.5) s-1, and Δrt -47 (-195 to 89) ms, all P < 0.05. At follow-up, regional stress-induced perfusion improved in 29 regions with successful PCI; Δβ 0.1 (-2.7 to 3.6), ΔA×β 30.5 (-133.3 to 232.1), and Δrt -99 (-247 to 125), all P ≤ 0.01, although there was no improvement in nine regions with restenosis; Δβ 0.9 (-1.5 to 5.3), ΔA×β 65.7 (-40.8 to 412.6), and Δrt -79 (-268 to 163), P = NS. Conclusion: Quantitative CSE has the potential to detect angiographically significant coronary artery stenoses as well as angiographic success after PCI.