Description
A 58-year old man, with a history of chest tightness and chest pain after activity, underwent coronary computed tomography (CTA) in the external hospital one year ago, which showed moderate stenosis in the proximal segment of left anterior descending artery (LAD) and left circumflex artery (LCX), and mild stenosis in right coronary artery (RCA). He was on medication but the symptoms had not improved significantly.
Key Finding(s)
There were ST-T changes in resting ECG in the clinic, while cardiac markers were normal. Considering that he was not suitable for treadmill exercise, we performed adenosine stress myocardial contrast echocardiography (MCE) for him to assess myocardial ischemia. In resting state, there were no obvious abnormalities in wall motion and myocardial perfusion (Figure 1). During peak stress, there were weakened wall motion of the anterior wall of the left ventricle and myocardial perfusion defect in the middle part of the interventricular septum, and the apical part of the left ventricle and the middle part of the lateral septum (Figure 2), which suggested that three-vessel disease was possible. Coronary angiography (CAG) showed diffuse lesions in the proximal and middle segment of LAD with more than 90% in the narrowest part, diffuse stenosis in the whole segment of LCX with 85% in the narrowest part, and 80% in the narrowest part of RCA (Figure 3-4). Then we implanted two stents in LAD and one stent in LCX. On the third day after operation, we re-examined adenosine stress MCE, which showed that wall motion and the perfusion of the anterior wall recovered in peak stage, except slight uneven perfusion in the apex (Figure 5-6).
Differential Diagnosis
1. stable angina pectoris.
2. chronic pericarditis.
3. chronic obstructive pulmonary disease
Implication(s)
This case describes a typical presentation of adenosine stress MCE as a non-invasive functional imaging method in the evaluation of myocardial ischemia for moderate stenosis in CTA, which can also be used for assessing the recovery of myocardial perfusion after percutaneous coronary intervention. Furthermore, adenosine stress MCE is safe to evaluate myocardial ischemia in patients with single-vessel or multi-vessel severe coronary artery disease.

Non-invasive Functional Imaging for Evaluation of Myocardial Ischemia with Moderate Stenosis

ECHO ASIA is organized by Asian-Pacific Association of Echocardiography (AAE). The meeting combines the basic echocardiography training curriculum and the state-of-the-art lectures/scientific sessions provided by international as well as Asian-Pacific experts. The meeting is a unique forum where scientists from many countries in the Asian-Pacific region who are involved in the field of Doppler echocardiography gather together to exchange knowledge and skills. Various internationally distinguished faculties consent to present their findings and reveal their clinical experiences in ECHO ASIA.