| Objective: Previous studies ST-MCE was safe and feasible for assessing perfusion in Myocardial microcirculation.However, little was known about differention and the role about the Adenosine Stressing Myocardial Contrast Echocardiography.As a result, the present study aimed at resolving several issues including: 1) To assess ischemic myocardium area by Myocardial contrast echocardiography(MCE). 2) To investigate the diagnostic value of myocardial contrast echocardiography (MCE) and the grade of TIMI in evaluating myocardial microcirculation perfusion and clinical applications.To assess resting myocardial perfusion by MCE in patients with coronary artery disease before and after PCI surgery. 3) To investigate the diagnostic value of adenosine stress myocardial contrast echocardiograph in assessing reserve of myocardial microcirculation before and after PCI surgery ,and to establishing the feasibility and clinical applications. Methods: 1) Eleven Open chest dogs were performed by in travenous MCE after ten minutes of left anterior descending coronary artery (LAD) occlusion for acute ischemia.M-mode of MCE defined the cut-off value of ischemic myocardium, and marked in anterior and inferior in 2D images, respectively. Ischemic area was curved and compared with pathologic result.Accoding TTC results ,put the aim on normal ?ischemic and suspicious area and analyzed quantitatively from microbubble replenishment curves for myocardial perfusion. 2) Thirty AMI and eleven ACS patients were examined by MCE using Sonovue intravenous injection before selective coronary angiograph.Thirty-six of patients were examined by MCE again after PCI surgery. The images of MCE were analyzed quantitatively from microbubble replenishment curves for myocardial perfusion .Left ventricular myocardial segments,divided into 4 groups according to the grade of TIMI of coronary artery detected by coronary artery angiography. Acoustic density parameters were compared among these groups, and the correlation between these parameters and the grade of TIMI of coronary artery .3) Thirty AMI and eleven ACS patients were examined by MCE at baseline and after adenosine stress administration before selective coronary angiograph.Thirty-six patients referred for PCI surgery . After and before PCI the patients were referred subsequent revascularization underwent MCE at baseline and after adenosine stress administration. The images of MCE were analyzed quantitatively from microbubble replenishment curves for myocardial perfusion and its reserve. Results: 1) There was correlation between Meis blue dye area and MCE ischemic area (r=0.93, P=0.01). There was correlation between TTC staining area and MCE ischemic area (r=0.68, P=0.01). Accoding TTC results ,the ischemic area in TTC is larger about 12.35±2.16mm than the ischemic area in MCE. The images of MCE were analyzed quantitatively from microbubble replenishment curves for myocardial perfusion. The A?βand A·βin the ischemic and suspicious area were significantly different versus the normal area. 2) Results among the 4 groups were significantly respectively (P<0.05), the A ?βand A·βwere decreased significantly with the grade of TIMI of coronary artery (all P<0.05); Before PCI surgery, A?β?and A·βwere significantly lower in the regions of interest with severe lower the grade of TIMI of coronary artery than those with normal coronary artery (P<0.05). the normalized value of Ar?βr?and A·βr were higher after PCI surgery than those before operation (P<0.05). 3) At baseline, significant differences in A ?βand A?βparameter were observed among groups of graded TIMI severity groups. Under adenosine stress,significant differences in A,βand A·βvalue could be observed among groups which showed that the lower the grade of TIMI severity, the lower the MCE parameters. Graded decreasing in the reserves of A,βand A·βcould also be observed with decreasing coronary the grade of TIMI severity. Furthermore, Some significant differences inβ, A·βcould be observed between segments with CBF and those without. Conclusion: 1) MCE is applicable to assess ischemic myocardium area. But defining myocardial infarct size by MCE ischemic area maybe lowly diagnose ischemia size,so we can improve by the A?βand A·βfrom microbubble replenishment curves for myocardial perfusion in 12.35±2.16mm out of the ischemic area in MCE. 2) Perfusion abnormalities are present in patients with severe lower the grade of TIMI of coronary artery and can be detected by MCE. However, myocardial microcirculation perfusion does not correlate with the grade of TIMI of coronary artery completely. further more, MCE can provide valuable information on t he outcome of coronary artery PCI surgery in these patients. 3) Quantitative MCE in conjunction with adenosine stress is feasible to identify and selsction AMI for PCI as well assesses the contribution of perfusion in myocardial microcirculation before or after PCI surgery.
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