Early diagnosis of coronary microvascular dysfunction by myocardial contrast stress echocardiography

Jucheng Zhang, Minwen Ma, Huajun Li, Zhaoxia Pu, Haipeng Liu, Tianhai Huang, Huan Cheng, Yinglan Gong, Yonghua Chu, Zhikang Wang, Jun Jiang, Ling Xia

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    4 Citations (Scopus)
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    Coronary microvascular dysfunction (CMD) is one of the basic mechanisms of myocardial ischemia. Myocardial contrast echocardiography (MCE) is a bedside technique that utilises microbubbles which remain entirely within the intravascular space and denotes the status of microvascular perfusion within that region. Some pilot studies suggested that MCE may be used to diagnose CMD, but without further validation. This study is aimed to investigate the diagnostic performance of MCE for the evaluation of CMD. MCE was performed at rest and during adenosine triphosphate stress. ECG triggered realtime frames were acquired in the apical 4-chamber, 3-chamber, 2-chamber, and long-axis imaging planes. These images were imported into Narnar for further processing. Eighty-two participants with suspicion of coronary disease and absence of significant epicardial lesions were prospectively investigated. Thermodilution was used as the gold standard to diagnose CMD. CMD was present in 23 (28%) patients. Myocardial blood flow reserve (MBF) was assessed using MCE. CMD was defined as MBF reserve < 2. The MCE method had a high sensitivity (88.1%) and specificity (95.7%) in the diagnosis of CMD. There was strong agreement with thermodilution (Kappa coefficient was 0.727; 95% CI: 0.57–0.88, p < 0.001). However, the correlation coefficient (r = 0.376; p < 0.001) was not high.
    Original languageEnglish
    Pages (from-to)7845-7858
    Number of pages14
    JournalMathematical Biosciences and Engineering
    Issue number5
    Publication statusPublished - 21 Feb 2023

    Bibliographical note

    ©2023 the Author(s), licensee AIMS Press. This is an open access
    article distributed under the terms of the Creative Commons
    Attribution License (http://creativecommons.org/licenses/by/4.0)


    This work is supported by the Natural Science Foundation of China (NSFC) under grant number 62171408 and the Key Research and Development Program of Zhejiang Province (2020C03060, 2020C03016, 2022C03111, 2023C03088). The authors thank Dr. Jiri Sklenar from Narnar, LLC for helpful instruction of MCE processing


    • coronary flow reserve
    • coronary microvascular dysfunction
    • myocardial contrast echocardiography
    • myocardial ischemia
    • myocardial perfusion

    ASJC Scopus subject areas

    • Modelling and Simulation
    • Agricultural and Biological Sciences(all)
    • Computational Mathematics
    • Applied Mathematics


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