Study of coronary flow reserve with intravenous use of microbubbles (contrast echocardiography) and adenosine: protocol for clinical application in patients suspected of having coronary heart disease

Arq Bras Cardiol. 2002 Mar;78(3):281-98. doi: 10.1590/s0066-782x2002000300004.
[Article in English, Portuguese]


Objective: To test the feasibility, safety and accuracy of the adenosine protocol in the study of myocardial perfusion with microbubbles contrast echocardiography.

Methods: 81 pts (64 male, 60+11 years) were submitted to contrast echocardiography with PESDA (sonicated solution of albumin 20%-1ml, dextrose 5%-12ml and deca-fluorobutane gas-8ml) to study the myocardial perfusion at rest and after bolus injection of adenosine (6 to 18mg) and to coronary angiography within 1 month each other. For each patient 3 left ventricle perfusion beds were considered (total of 243 territories). 208 territories were analyzed and 35 territories were excluded. PESDA was continuously infused (1-2ml/min), titrated for best myocardial contrast. Triggered (1:1) second harmonic imaging was used.

Results: Coronary angiography showed 70 flow limiting (> 75%) lesions and 138 no flow limiting lesions. At rest an obvious myocardium contrast enhancement was seen in at least 1 segment of a territory in all patients. After adenosine injection an unquestionable further increase in myocardial contrast was observed in 136 territories (99%) related to no flow limiting lesions, lasting < 10 s, and a myocardial perfusion defect was detected in 68 territories (97%) related to flow limiting lesions. It was observed only 4 false results. There were no serious complications.

Conclusion: Myocardial perfusion study with PESDA and adenosine protocol is a practical, safe and accurate method to analyze the coronary flow reserve.

MeSH terms

  • Adenosine*
  • Adult
  • Aged
  • Aged, 80 and over
  • Clinical Protocols
  • Contrast Media
  • Coronary Angiography
  • Coronary Circulation / physiology*
  • Coronary Disease / diagnostic imaging*
  • Coronary Disease / physiopathology
  • Echocardiography / methods*
  • Feasibility Studies
  • Female
  • Hemodynamics
  • Humans
  • Injections, Intravenous
  • Male
  • Middle Aged
  • Rest
  • Vasodilator Agents*


  • Contrast Media
  • Vasodilator Agents
  • Adenosine