Contrast Echocardiography: A New Method for the Assesment of Myocardial Perfusion in Coronary Artery Disease

highly suited to the non-invasive assessment of myocardial function. Changes in myocardial perfusion can be depicted by echocardiography indirectly as wall motion and thickening abnormalities. Regional left ventricular systolic function estimation is useful in the detection of ischemic but viable myocardium and provides information of paramount importance concerning the management of patients with ischemic cardiomyopathy. During the past several years through advances in contrast agents and ultrasound technology, myocardial contrast echocardiography (MCE) has reached the stage where it is able to detect and evaluate coronary artery disease based on an evaluation of the myocardial perfusion. Left ventricular dysfunction due to coronary artery disease does not necessarily suggest myocardial necrosis. Dysfunctional but viable myocardium may be the consequence of aprolonged ischemic episode or chronic hypoperfusion unrelated to the coexistence of myocardial necrosis and b. to chronic coronary artery disease with or without reduction of the systolic function. The methods used in the clinical setting for detection of ischemia and the evaluation of myocardial viability that will correspond to invasive techniques, are positron emission tomography (PET), Tl or technetium-99m, single photon emission computed tomography (SPECT) and low dose dobutamine stress echocardiography (DSE). Recent data proved that other techniques such as contrast-enhanced magnetic resonance and MCE can be used to assess dysfunctional myocardial tissue and hence to predict which patients will benefit from revascularization techiques. This review focuses on the value of MCE in assessing myocardial perfusion in patients with coronary artery disease.